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Marmor M, Burcham JL, Chen LC, Chillrud SN, Graham JK, Jordan HT, Zhong M, Halzack E, Cone JE, Shao Y. Trace and Major Element Concentrations in Cadaveric Lung Tissues from World Trade Center Health Registry Decedents and Community Controls. Int J Environ Res Public Health 2023; 20:6923. [PMID: 37887662 PMCID: PMC10606593 DOI: 10.3390/ijerph20206923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023]
Abstract
Studies of the health impacts of the 11 September 2001 terrorist attacks on New York City's (NYC's) World Trade Center (WTC) towers have been hindered by imprecise estimates of exposure. We sought to identify potential biomarkers of WTC exposure by measuring trace and major metal concentrations in lung tissues from WTC-exposed individuals and less exposed community controls. We also investigated associations of lung tissue metal concentrations with self-reported exposure and respiratory symptoms. The primary analyses contrasted post-mortem lung tissue concentrations obtained from autopsies in 2007-2011 of 76 WTC Health Registry (WTCHR) enrollees with those of 55 community controls. Community controls were frequency-matched to WTCHR decedents by age at death, calendar quarter of death, gender, race, ethnicity and education and resided at death in NYC zip codes less impacted by WTC dust and fumes. We found WTCHR decedents to have significantly higher iron (Fe) lung tissue concentrations than community controls. Secondary analyses among WTCHR decedents adjusted for sex and age showed the log(molybdenum (Mo)) concentration to be significantly associated with non-rescue/recovery exposure. Post hoc analyses suggested that individuals whose death certificates listed usual occupation or industry as the Sanitation or Police Departments had elevated lung tissue Fe concentrations. Among WTCHR decedents, exposure to the WTC dust cloud was significantly associated with elevated lung tissue concentrations of titanium (Ti), chromium (Cr) and cadmium (Cd) in non-parametric univariable analyses but not in multivariable analyses adjusted for age and smoking status. Logistic regression adjusted for age and smoking status among WTCHR decedents showed one or more respiratory symptoms to be positively associated with log (arsenic (As)), log(manganese (Mn)) and log(cobalt (Co)) concentrations, while new-onset wheezing and sinus problems were negatively associated with log(Fe) concentration. Fe concentrations among individuals with wheezing, nonetheless, exceeded those in community controls. In conclusion, these data suggest that further research may be warranted to explore the utility as biomarkers of WTC exposure of Fe in particular and, to a lesser extent, Mo, Ti, Cr and Cd in digestions of lung tissue.
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Affiliation(s)
- Michael Marmor
- Departments of Population Health and Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Joyce L. Burcham
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (J.L.B.); (Y.S.)
| | - Lung-Chi Chen
- Division of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Steven N. Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY 10964, USA;
| | - Jason K. Graham
- New York City Office of Chief Medical Examiner and Department of Forensic Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Hannah T. Jordan
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 11101, USA; (H.T.J.); (J.E.C.)
| | - Mianhua Zhong
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Elizabeth Halzack
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - James E. Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 11101, USA; (H.T.J.); (J.E.C.)
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (J.L.B.); (Y.S.)
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Jorge A, Melles R, Marmor M, Conell C, Zhou B, Niu J, Zhang Y, Choi H. POS0370 COMPARATIVE RETINOPATHY RISK OF HIGH- VS LOW-DOSE HYDROXYCHLOROQUINE AMONG 4,677 INCIDENT LONG-TERM USERS: EMULATED TARGET TRIAL ANALYSES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1671] [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: 11/04/2022]
Abstract
BackgroundHydroxychloroquine (HCQ) is a key treatment for patients with lupus, but the major long-term toxicity is HCQ retinopathy. A large cross-sectional study found a prevalence of HCQ retinopathy of 7.5% overall and 5 times higher odds associated with HCQ dose >5 mg/kg/day, which led to ophthalmology guidelines recommending the avoidance of HCQ dosing >5 mg/kg.1 However, whether this dosing recommendation is applicable to the future risk of HCQ retinopathy is unknown, as is the incidence of severe bullseye retinopathy vs. the mild, pre-symptomatic stage. Furthermore, recent studies have indicated that the use of lower doses of HCQ may increase the risk of lupus flares and hospitalizations.2ObjectivesTo determine the incidence of HCQ retinopathy associated with long-term HCQ use and compare them according to HCQ dose.MethodsWe emulated a hypothetical target trial using observational data3 from the US integrated health network Kaiser Permanente Northern California to compare two HCQ weight-based dosing strategies, >5 vs ≤5 mg/kg/day, based on dispensed tablets per year. A secondary analysis evaluated >80% of prescription days covered by dispensed tablets per year with HCQ dose >5 vs ≤5 mg/kg. We included 4,677 patients who initiated and continued HCQ for at least 5 years between 1997-2020. We emulated randomization of treatment strategy by cloning each subject and assigning a replicate to each treatment group.3 We censored replicates if and when they deviated from the assigned treatment group, assessed as the average dose in the first 5 years and annually thereafter. We used inverse probability weighting to account for censoring. The primary outcome was HCQ retinopathy, assessed by expert adjudication of spectral domain-optical coherence tomography (SD-OCT) and graded by severity. All SD-OCTs were prospectively reviewed by an expert ophthalmologist (RM), and a second expert ophthalmologist (MM) reviewed all abnormal scans and a random subset of normal scans. We assessed intra-rater reliability of SD-OCT findings. We used pooled logistic regression to estimate the cumulative incidence of HCQ retinopathy for each HCQ dose strategy from initiation. The odds ratios approximated hazard ratios (HRs) because the outcome at each one-year time block is <5%.ResultsAmong 4,677 patients, the mean age at HCQ initiation was 52 years; 83% were female. The racial/ethnic composition included 51% non-Hispanic White, 19% Hispanic, 14% Asian, and 11% Black patients. 756 (16.2%) and 3,921 (83.8%) patients initiated HCQ with the primary definition of the treatment strategies >5 and ≤5 mg/kg/day, respectively. The weighted kappa was 0.80 for SD-OCT reliability. 164 patients developed HCQ retinopathy (100 mild, 38 moderate, and 26 severe cases). The cumulative incidence of retinopathy over 18 years was 37.6% for >5 and 5.7% for ≤5mg/kg of HCQ in our primary analysis. The corresponding risk was 26.5% for >5 and 3.2% for ≤5 mg/kg in our secondary analysis using >80% of prescription days. Compared with ≤5 mg/kg of HCQ, the HRs of retinopathy were 9.65 (95% CI 5.73-16.65) and 10.79 (95% CI 6.40-20.07) for >5 mg/kg using the primary and secondary definitions of HCQ dose categories, respectively (Figure 1).ConclusionThe risk of HCQ retinopathy associated with long-term adherence to >5 mg/kg dosing was high, approximately 10 times that of ≤5 mg/kg dosing. However, most cases identified during the study were mild and pre-symptomatic, supporting the value of regular screening. These data should be incorporated into individualized decisions about long-term use of HCQ.References[1]Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol 2014;132(12):1453-60[2]Almeida-Brasil CC et al. Flares after hydroxychloroquine reduction or discontinuation: results from the SLICC inception cohort. Ann Rheum Dis 2021 Dec 15, epub ahead of print[3]Hernán MA, Robins JM. Using Big Data to Emulate a Target Trial When a Randomized Trial Is Not Available. Am J Epidemiol 2016;183(8):758-64Disclosure of InterestsApril Jorge: None declared, Ronald Melles: None declared, Michael Marmor: None declared, Carol Conell: None declared, Baijun Zhou: None declared, Jingbo Niu: None declared, Yuqing Zhang: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart., Grant/research support from: Ironwood and Horizon
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Marmor M, DiMaggio C, Friedman-Jimenez G, Shao Y. Quality improvement tool for rapid identification of risk factors for SARS-CoV-2 infection among healthcare workers. J Hosp Infect 2020; 105:710-716. [PMID: 32553893 PMCID: PMC7293763 DOI: 10.1016/j.jhin.2020.06.012] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/08/2020] [Indexed: 12/29/2022]
Abstract
The rapid growth of the coronavirus disease 2019 (COVID-19) pandemic, limited availability of personal protective equipment, and uncertainties regarding transmission modes of severe acute respiratory syndrome coronavirus-2 have heightened concerns for the safety of healthcare workers (HCWs). Systematic studies of occupational risks for COVID-19 in the context of community risks are difficult and have only recently started to be reported. Ongoing quality improvement studies in various locales and within many affected healthcare institutions are needed. A template design for small-scale quality improvement surveys is proposed. Such surveys have the potential for rapid implementation and completion, are cost-effective, impose little administrative or workforce burden, can reveal occupational risks while taking community risks into account, and can be repeated easily with short time intervals between repetitions. This article describes a template design and proposes a survey instrument that is easily modifiable to fit the particular needs of various healthcare institutions in the hope of beginning a collaborative effort to refine the design and instrument. These methods, along with data management and analytic techniques, can be widely useful and shared globally. The authors' goal is to facilitate quality improvement surveys aimed at reducing the risk of occupational infection of HCWs during the COVID-19 pandemic.
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Affiliation(s)
- M Marmor
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA.
| | - C DiMaggio
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - G Friedman-Jimenez
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA; Bellevue/NYU Occupational Environmental Medicine Clinic, New York, NY, USA
| | - Y Shao
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA.
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Marmor M, Thawani S, Cotrina ML, Shao Y, Wong ES, Stecker MM, Wang B, Allen A, Wilkenfeld M, Vinik EJ, Vinik AI, Reibman J. Case-Control Study of Paresthesia Among World Trade Center-Exposed Community Members. J Occup Environ Med 2020; 62:307-316. [PMID: 32049876 PMCID: PMC7113112 DOI: 10.1097/jom.0000000000001828] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate whether paresthesia of the lower extremities following exposure to the World Trade Center (WTC) disaster was associated with signs of neuropathy, metabolic abnormalities, or neurotoxin exposures. METHODS Case-control study comparing WTC-exposed paresthesia cases with "clinic controls" (WTC-exposed subjects without paresthesias), and "community controls" (WTC-unexposed persons). RESULTS Neurological histories and examination findings were significantly worse in cases than controls. Intraepidermal nerve fiber densities were below normal in 47% of cases and sural to radial sensory nerve amplitude ratios were less than 0.4 in 29.4%. Neurologic abnormalities were uncommon among WTC-unexposed community controls. Metabolic conditions and neurotoxin exposures did not differ among groups. CONCLUSIONS Paresthesias among WTC-exposed individuals were associated with signs of neuropathy, small and large fiber disease. The data support WTC-related exposures as risk factors for neuropathy, and do not support non-WTC etiologies.
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Affiliation(s)
- Michael Marmor
- Department of Population Health, New York University School
of Medicine, USA
- Department of Environmental Medicine, New York University
School of Medicine, USA
- Department of Medicine, New York University School of
Medicine, USA
| | - Sujata Thawani
- Department of Neurology, New York University School of
Medicine, USA
| | | | - Yongzhao Shao
- Department of Population Health, New York University School
of Medicine, USA
- Department of Environmental Medicine, New York University
School of Medicine, USA
| | - Ericka S. Wong
- Department of Neurology, New York University School of
Medicine, USA
- Department of Neurology, Thomas Jefferson University
Hospital, Philadelphia, PA, USA
| | - Mark M. Stecker
- UCSF/Fresno and University Neurology Associates, Fresno,
CA, USA
| | - Bin Wang
- Department of Population Health, New York University School
of Medicine, USA
- Department of Environmental Medicine, New York University
School of Medicine, USA
| | | | - Marc Wilkenfeld
- Department of Medicine, New York University School of
Medicine, USA
- Division of Occupational and Environmental Medicine,
Department of Medicine, NYU Winthrop Hospital, Mineola, NY, USA
| | - Etta J. Vinik
- Department of Internal Medicine, Strelitz Diabetes Center,
Eastern Virginia Medical School, Norfolk, VA, USA
| | - Aaron I. Vinik
- Department of Internal Medicine, Strelitz Diabetes Center,
Eastern Virginia Medical School, Norfolk, VA, USA
| | - Joan Reibman
- Department of Environmental Medicine, New York University
School of Medicine, USA
- Department of Medicine, New York University School of
Medicine, USA
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Lorach H, Kang S, Bhuckory MB, Trouillet A, Dalal R, Marmor M, Palanker D. Transplantation of Mature Photoreceptors in Rodents With Retinal Degeneration. Transl Vis Sci Technol 2019; 8:30. [PMID: 31171997 PMCID: PMC6543858 DOI: 10.1167/tvst.8.3.30] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/01/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To demonstrate survival and integration of mature photoreceptors transplanted with the retinal pigment epithelium (RPE). Methods Full-thickness retina with attached RPE was harvested from healthy adult rats. Grafts were implanted into two rat models of retinal degeneration, Royal College of Surgeons (RCS) and S334ter-3. Survival of the host and transplanted retina was monitored using optical coherence tomography (OCT) for up to 6 months. The retinal structure and synaptogenesis between the host and transplant was assessed by histology and immunohistochemistry. Results OCT and histology demonstrated a well-preserved photoreceptor layer with inner and outer segments, while the inner retinal layers of the transplant largely disappeared. Grafts, including RPE, survived better than without and the transplanted RPE appeared as a monolayer integrated with the native one. Synaptogenesis was observed through sprouting of new dendrites from the host bipolar cells and synaptic connections forming with cells of the transplant. However, in many samples, a glial fibrillary acidic protein–positive membrane separated the host retina and the graft. Conclusions Presence of RPE in the graft improved the survival of transplanted photoreceptors. Functional integration between the transplant and the host retina is likely to be further enhanced if formation of a glial seal could be prevented. Transplantation of the mature photoreceptors with RPE may be a practical approach to restoration of sight in retinal degeneration. Translational Relevance This approach to restoration of sight in patients with photoreceptor degeneration can be rapidly advanced to clinical testing. In patients with central scotoma, autologous transplantation of the peripheral retina can be an option.
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Affiliation(s)
- Henri Lorach
- Hansen Experimental Physics Laboratory, Stanford University, CA, USA
| | - Seungbum Kang
- Hansen Experimental Physics Laboratory, Stanford University, CA, USA.,Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mohajeet B Bhuckory
- Hansen Experimental Physics Laboratory, Stanford University, CA, USA.,Department of Ophthalmology, Stanford University, CA, USA
| | - Alix Trouillet
- Department of Otolaryngology, Stanford University, CA, USA
| | - Roopa Dalal
- Department of Ophthalmology, Stanford University, CA, USA
| | - Michael Marmor
- Department of Ophthalmology, Stanford University, CA, USA
| | - Daniel Palanker
- Hansen Experimental Physics Laboratory, Stanford University, CA, USA.,Department of Ophthalmology, Stanford University, CA, USA
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Gaylord A, Berger KI, Naidu M, Attina TM, Gilbert J, Koshy TT, Han X, Marmor M, Shao Y, Giusti R, Goldring RM, Kannan K, Trasande L. Serum perfluoroalkyl substances and lung function in adolescents exposed to the World Trade Center disaster. Environ Res 2019; 172:266-272. [PMID: 30822559 PMCID: PMC8336627 DOI: 10.1016/j.envres.2019.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 05/04/2023]
Abstract
The effects of childhood exposure to perfluoroalkyl substances (PFASs) on lung function remain mostly unknown. Previous research indicates that children living or going to school near the World Trade Center (WTC) disaster were exposed to high levels of PFASs, among other toxic chemicals. To explore the effects of PFAS exposure on lung function, we measured serum PFASs in a cohort of children from the WTC Health Registry and a matched control group. Perfluorooctanesulfonate had the highest median concentrations in both groups (WTCHR = 3.72 ng/mL, Comparison = 2.75 ng/mL), while the lowest median concentrations were seen for perfluoroundecanoic acid (WTCHR = 0.12 ng/mL, Comparison = 0.01 ng/mL). Lung function outcomes were measured by spirometry, plethysmography, and oscillometry. Asthma diagnosis and serum eosinophil count were also recorded. We examined the relationships of each PFAS with lung function parameters and eosinophil count using linear regressions. Odds ratios for asthma were obtained for each PFAS using logistic regression. The effect of total PFASs on these outcomes was also assessed. All regression models were adjusted for sex, race/ethnicity, age, body mass index (BMI) and tobacco smoke exposure. We found that serum PFASs were not statistically associated with the measured lung function parameters, asthma diagnosis, or eosinophil count in this cohort (p < 0.05). These findings highlight the need for more longitudinal studies to explore the long-term effects of childhood PFAS exposure on lung function past adolescence and early adulthood.
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Affiliation(s)
- Abigail Gaylord
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Kenneth I Berger
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Mrudula Naidu
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Teresa M Attina
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Joseph Gilbert
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Tony T Koshy
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Xiaoxia Han
- Public Health Sciences Department, Henry Ford Health System, Detroit, MI, USA
| | - Michael Marmor
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Robert Giusti
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Roberta M Goldring
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | | | - Leonardo Trasande
- Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Medicine, New York University School of Medicine, New York, NY, USA; Departments of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
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Thawani S, Wang B, Shao Y, Reibman J, Marmor M. Time to Onset of Paresthesia Among Community Members Exposed to the World Trade Center Disaster. Int J Environ Res Public Health 2019; 16:ijerph16081429. [PMID: 31013580 PMCID: PMC6518362 DOI: 10.3390/ijerph16081429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 02/04/2023]
Abstract
We examined whether time to onset of paresthesia was associated with indicators of severity of World Trade Center (WTC) exposure. We analyzed data from 3411 patients from the Bellevue Hospital—WTC Environmental Health Center. Paresthesia was defined as present if the symptom occurred in the lower extremities with frequency “often” or “almost continuous.” We plotted hazard functions and used the log-rank test to compare time to onset of paresthesia between different exposure groups. We also used Cox regression analysis to examine risk factors for time-to-paresthesia after 9/11/2001 and calculate hazard ratios adjusted for potential confounders. We found significantly elevated hazard ratios for paresthesia for (a) working in a job that required cleaning of WTC dust in the workplace; and (b) being heavily exposed to WTC dust on September 11, 2001, after adjusting for age, race/ethnicity, depression, anxiety, post-traumatic stress disorder, and body mass index. These observational data are consistent with the hypothesis that exposure to WTC dust or some other aspect of cleaning WTC dust in the workplace, is associated with neuropathy and paresthesia. Further neurological evaluations of this and other WTC-exposed populations is warranted.
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Affiliation(s)
- Sujata Thawani
- Department of Neurology, New York University School of Medicine, New York, NY 10017, USA.
| | - Bin Wang
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA.
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA.
| | - Joan Reibman
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA.
- Department of Medicine, New York University School of Medicine, New York, NY 10016, USA.
| | - Michael Marmor
- Department of Neurology, New York University School of Medicine, New York, NY 10017, USA.
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
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Trye A, Berger KI, Naidu M, Attina TM, Gilbert J, Koshy TT, Han X, Marmor M, Shao Y, Giusti R, Goldring RM, Trasande L. Respiratory Health and Lung Function in Children Exposed to the World Trade Center Disaster. J Pediatr 2018; 201:134-140.e6. [PMID: 30029866 PMCID: PMC8336626 DOI: 10.1016/j.jpeds.2018.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/09/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To compare lung function in a representative sample of World Trade Center (WTC)-exposed children with matched comparisons, and examine relationships with reported exposures. STUDY DESIGN Study population consisted of 402 participants. Oscillometry, spirometry, and plethysmography were performed on WTC Health Registry (WTCHR) respondents who were ≤8 years of age on September 11, 2001 (n = 180) and a sociodemographically matched group of New York City residents (n = 222). We compared lung function by study arm (WTCHR and comparison group) as well as dust cloud (acute); home dust (subchronic); and other traumatic, nondust exposures. RESULTS In multivariable models, post-9/11 risk of incident asthma was higher in the WTCHR participants than in the comparison group (OR 1.109, 95% CI 1.021, 1.206; P = .015). Comparing by exposure rather than by group, dust cloud (OR 1.223, 95% CI 1.095, 1.365; P < .001) and home dust (OR 1.123, 95% CI 1.029, 1.226; P = .009) exposures were also associated with a greater risk of incidence of post-9/11 asthma. No differences were identified for lung function measures. CONCLUSIONS Although we cannot exclude an alternative explanation to the null findings, these results may provide some measure of reassurance to exposed children and their families regarding long-term consequences. Further study with bronchodilation and/or methacholine challenge may be needed to identify and further evaluate effects of WTC exposure. Biomarker studies may also be more informative in delineating exposure-outcome relationships. TRIAL REGISTRATION ClinicalTrials.gov: NCT02068183.
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Affiliation(s)
- Alice Trye
- Department of Pediatrics, New York University School of Medicine
| | | | - Mrudula Naidu
- Department of Pediatrics, New York University School of Medicine
| | - Teresa M. Attina
- Department of Pediatrics, New York University School of Medicine
| | - Joseph Gilbert
- Department of Pediatrics, New York University School of Medicine
| | - Tony T. Koshy
- Department of Pediatrics, New York University School of Medicine
| | - Xiaoxia Han
- Department of Population Health, New York University School of Medicine
| | - Michael Marmor
- Department of Population Health, New York University School of Medicine
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine;,Department of Environmental Medicine, New York University School of Medicine
| | - Robert Giusti
- Department of Pediatrics, New York University School of Medicine
| | | | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY; Department of Population Health, New York University School of Medicine, New York, NY; Department of Environmental Medicine, New York University School of Medicine, New York, NY; New York University Wagner School of Public Service, New York, NY; New York University College of Global Public Health, New York, NY.
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Trasande L, Koshy TT, Gilbert J, Burdine LK, Marmor M, Han X, Shao Y, Chemtob C, Attina TM, Urbina EM. Cardiometabolic profiles of adolescents and young adults exposed to the World Trade Center Disaster. Environ Res 2018; 160:107-114. [PMID: 28972913 PMCID: PMC5712452 DOI: 10.1016/j.envres.2017.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/25/2017] [Accepted: 09/21/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Few studies have examined the possible cardiometabolic consequences of World Trade Center-related exposures on children who lived and/or attended school near the disaster site. Our objective was to compare cardiometabolic profiles of participants in the World Trade Center Health Registry (WTCHR) with a matched comparison group. METHODS We evaluated WTCHR enrollees who resided in New York City and were born between September 11, 1993 and September 10, 2001, and a matched comparison group. We assessed exposure to dust cloud, home dust, as well as traumatic exposure, and associations with blood pressure, arterial wall stiffness, body mass index (BMI), total cholesterol, triglycerides, HDL, and LDL. RESULTS A total of 402 participants completed the study, 222 in the comparison group and 180 in the WTCHR group. In multivariable regression analysis, after adjusting for relevant confounders we detected a weak association between participation in the WTCHR group and lower BMI (-1.12kg/m2, 95% CI -2.11, -0.12; p = 0.03), which became non-significant after adjusting for multiple comparisons. With respect to traumatic and psychosocial exposures, the only association that persisted in our multivariable model, below our predefined level of significance, was between post-traumatic stress disorder and higher BMI (2.06kg/m2, 95% CI 0.37, 3.74; p = 0.02). CONCLUSIONS Our findings do not support an association between self-reported exposures to the WTC disaster and adverse cardiometabolic profile. However, further longitudinal studies may better inform the full extent of WTC-related conditions associated with exposure to the disaster.
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Affiliation(s)
- Leonardo Trasande
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA; Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
| | - Tony T Koshy
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Joseph Gilbert
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Lauren K Burdine
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Michael Marmor
- Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA; Medicine, New York University School of Medicine, New York, NY, USA
| | - Xiaoxia Han
- Population Health, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA
| | - Claude Chemtob
- Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Teresa M Attina
- Departments of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, OH, USA
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10
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Koshy TT, Attina TM, Ghassabian A, Gilbert J, Burdine LK, Marmor M, Honda M, Chu DB, Han X, Shao Y, Kannan K, Urbina EM, Trasande L. Serum perfluoroalkyl substances and cardiometabolic consequences in adolescents exposed to the World Trade Center disaster and a matched comparison group. Environ Int 2017; 109:128-135. [PMID: 28890218 PMCID: PMC5660646 DOI: 10.1016/j.envint.2017.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 05/02/2023]
Abstract
BACKGROUND Large amounts of various chemical contaminants, including perfluoroalkyl substances (PFASs), were released at the time of the World Trade Center (WTC) disaster. Thousands of children who lived and/or attended school near the disaster site were exposed to these substances but few studies have examined the possible consequences related to these exposures. OBJECTIVES To examine the relationship of PFASs serum levels with cardiometabolic profile in children and adolescents enrolled in the World Trade Center Health Registry (WTCHR) and a matched comparison group. METHODS We evaluated WTCHR enrollees who resided in New York City and were born between September 11, 1993 and September 10, 2001, and a matched comparison group consisting of individuals who were ineligible for WTCHR participation upon distance of their home, school or work from the WTC and lack of participation in rescue and recovery activities. Matching was based on date of birth, sex, race, ethnicity, and income. We assessed exposure to PFASs, as measured by serum levels and association with cardiometabolic profile as measured by arterial wall stiffness, body mass index, insulin resistance, fasting total cholesterol, HDL, LDL and triglycerides. RESULTS A total of 402 participants completed the study and serum samples were analyzed from 308 participants, 123 in the WTCHR group and 185 in the comparison group. In multivariable regression analysis, after adjusting for relevant confounders, we observed a significant, positive association of perfluorooctanoic acid (PFOA) with triglycerides (beta coefficient=0.14, 95% CI: 0.02, 0.27, 15.1% change), total cholesterol (beta coefficient=0.09, 95% CI: 0.04, 0.14, 9.2% change), and LDL cholesterol (beta coefficient=0.11, 95% CI: 0.03, 0.19, 11.5% change). Perfluorohexanesulfonic acid levels were associated with decreased insulin resistance (beta coefficient=-0.09, 95% CI: -0.18, -0.003, -8.6% change); PFOA and perfluorononanoic acid were associated with increased brachial artery distensibility. CONCLUSIONS This research adds to our knowledge of the physical health impacts in a large group of children exposed to the WTC disaster. Abnormal lipid levels in young adults might be an early marker of atherosclerosis and cardiovascular diseases and our findings highlight the importance of conducting longitudinal studies in this population.
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Affiliation(s)
- Tony T Koshy
- Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Teresa M Attina
- Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Akhgar Ghassabian
- Pediatrics, New York University School of Medicine, New York, NY, USA; Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Joseph Gilbert
- Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Lauren K Burdine
- Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Michael Marmor
- Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA; Medicine, New York University School of Medicine, New York, NY, USA
| | - Masato Honda
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Dinh Binh Chu
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Xiaoxia Han
- Population Health, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA
| | | | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Leonardo Trasande
- Pediatrics, New York University School of Medicine, New York, NY, USA; Environmental Medicine, New York University School of Medicine, New York, NY, USA; Population Health, New York University School of Medicine, New York, NY, USA; Medicine, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
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Rosen RL, Levy-Carrick N, Reibman J, Xu N, Shao Y, Liu M, Ferri L, Kazeros A, Caplan-Shaw CE, Pradhan DR, Marmor M, Galatzer-Levy IR. Elevated C-reactive protein and posttraumatic stress pathology among survivors of the 9/11 World Trade Center attacks. J Psychiatr Res 2017; 89:14-21. [PMID: 28135632 DOI: 10.1016/j.jpsychires.2017.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/15/2016] [Accepted: 01/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Systemic inflammation has emerged as a promising marker and potential mechanism underlying post-traumatic stress disorder (PTSD). The relationship between posttraumatic stress pathology and systemic inflammation has not, however, been consistently replicated and is potentially confounded by comorbid illness or injury, common complications of trauma exposure. METHODS We analyzed a large naturalistic cohort sharing a discrete physical and mental health trauma from the destruction of the World Trade Center (WTC) towers on September 11, 2001 (n = 641). We evaluated the relationship between multiple physical and mental health related indices collected through routine evaluations at the WTC Environmental Health Center (WTC EHC), a treatment program for community members exposed to the disaster. C-Reactive Protein (CRP), a marker of systemic inflammation, was examined in relation to scores for PTSD, PTSD symptom clusters (re-experiencing, avoidance, negative cognitions/mood, arousal), depression and anxiety, while controlling for WTC exposures, lower respiratory symptoms, age, sex, BMI and smoking as potential risks or confounders. RESULTS CRP was positively associated with PTSD severity (p < 0.001), trending toward association with depression (p = 0.06), but not with anxiety (p = 0.27). CRP was positively associated with re-experiencing (p < 0.001) and avoidance (p < 0.05) symptom clusters, and trended toward associations with negative cognitions/mood (p = 0.06) and arousal (p = 0.08). CONCLUSIONS In this large study of the relationship between CRP and posttraumatic stress pathology, we demonstrated an association between systemic inflammation and stress pathology (PTSD; trending with depression), which remained after adjusting for potentially confounding variables. These results contribute to research findings suggesting a salient relationship between inflammation and posttraumatic stress pathology.
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Affiliation(s)
- Rebecca L Rosen
- NYU School of Medicine, Department of Psychiatry, 550 First Ave, New York, NY 10016, United States; Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States.
| | - Nomi Levy-Carrick
- NYU School of Medicine, Department of Psychiatry, 550 First Ave, New York, NY 10016, United States; Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States
| | - Joan Reibman
- Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Medicine, 550 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Environmental Medicine, 550 First Ave, New York, NY 10016, United States
| | - Ning Xu
- NYU School of Medicine, Department of Population Health, 650 First Ave, Fifth Floor, New York, NY 10016, United States
| | - Yongzhao Shao
- Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Population Health, 650 First Ave, Fifth Floor, New York, NY 10016, United States
| | - Mengling Liu
- Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Population Health, 650 First Ave, Fifth Floor, New York, NY 10016, United States
| | - Lucia Ferri
- NYU School of Medicine, Department of Psychiatry, 550 First Ave, New York, NY 10016, United States; Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States
| | - Angeliki Kazeros
- Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Medicine, 550 First Ave, New York, NY 10016, United States
| | - Caralee E Caplan-Shaw
- Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Medicine, 550 First Ave, New York, NY 10016, United States
| | - Deepak R Pradhan
- Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Medicine, 550 First Ave, New York, NY 10016, United States
| | - Michael Marmor
- Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Population Health, 650 First Ave, Fifth Floor, New York, NY 10016, United States
| | - Isaac R Galatzer-Levy
- NYU School of Medicine, Department of Psychiatry, 550 First Ave, New York, NY 10016, United States; Steven and Alexandra Cohen Veteran's Center, NYU Langone Medical Center, 550 First Ave, New York, NY 10016, United States
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Trasande L, Koshy TT, Gilbert J, Burdine LK, Attina TM, Ghassabian A, Honda M, Marmor M, Chu DB, Han X, Shao Y, Kannan K. Serum perfluoroalkyl substances in children exposed to the world trade center disaster. Environ Res 2017; 154:212-221. [PMID: 28104511 PMCID: PMC5328959 DOI: 10.1016/j.envres.2017.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/06/2017] [Accepted: 01/08/2017] [Indexed: 05/18/2023]
Abstract
The World Trade Center (WTC) disaster released large amounts of various chemical substances into the environment, including perfluoroalkyl substances (PFASs). Yet, no studies have examined exposures in children living or attending schools near the disaster site. We measured serum PFASs in WTC Health Registry (WTCHR) respondents who were ≤8 years of age on September 11, 2001 and a sociodemographically-matched comparison group. We also examined the relationship of PFASs levels with dust cloud exposure; home dust exposure, and with traumatic exposure, the latter to take into account differences related to possible mental health consequences and associated behavioral problems. Serum samples, collected between 2014 and 2016, were analyzed from 123 WTCHR participants and from 185 participants in the comparison group. In the WTCHR group, median perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) levels were 1.81ng/mL and 3.72ng/mL, respectively. Controlling for sex, caloric intake, race/ethnicity, and date of birth, significant increases among WTCHR participants compared with the matched comparison group were detected for perfluorohexanesulfonate (0.23ng/mL increase or 0.24log unit increase, p=0.006); PFOS (0.86ng/mL increase or 0.16log unit increase, p=0.011); PFOA (0.35ng/mL increase or 0.18log unit increase, p<0.001); perfluorononanoic acid (0.12ng/mL increase or 0.17log unit increase, p=0.003); perfluorodecanoic acid (0.06ng/mL increase or 0.42log unit increase, p<0.001); and perfluoroundecanoic acid (0.03ng/mL increase or 0.32log unit increase, p=0.019). Stronger associations were identified for home dust exposures and traumatic exposures than dust cloud. These findings highlight the importance of conducting longitudinal studies in this population to assess possible cardiometabolic and renal consequences related to these exposures.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Medicine, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
| | - Tony T Koshy
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Joseph Gilbert
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Lauren K Burdine
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Teresa M Attina
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Masato Honda
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Michael Marmor
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Dinh Binh Chu
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Xiaoxia Han
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA
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13
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Leisy HB, Ahmad M, Marmor M, Smith RT. Association between Decreased Renal Function and Reticular Macular Disease in Age-Related Macular Degeneration. Ophthalmol Retina 2017; 1:42-48. [PMID: 31047393 DOI: 10.1016/j.oret.2016.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare renal function in patients with age-related macular degeneration (AMD) with and without concurrent reticular macular disease (RMD). DESIGN Retrospective cohort study. PARTICIPANTS Patients with documented AMD with and without RMD. METHODS Via our electronic health record system, we retrospectively identified patients assigned an International Classification of Diseases, Ninth Edition, code associated with AMD between January 2012 and January 2016. Patients met inclusion criteria if they had at least 1 macular spectral-domain optical coherence tomography volume scan, 1 provider note, and 1 glomerular filtration rate (GFR) value in the electronic medical record. We evaluated images for the presence or absence of RMD; we defined RMD as the presence of at least 1 subretinal drusenoid deposit in at least 1 macular slice. Patients with RMD in at least 1 eye were deemed RMD positive. Patients with bilateral choroidal neovascularization were excluded from analysis. MAIN OUTCOME MEASURE Observation of renal function in RMD patients. RESULTS Inclusion criteria were met by 119 patients (mean age, 75 years; range, 46-101 years). To account for the significant difference in RMD prevalence at extreme ages, we limited our study population to 107 patients 50 to 90 years of age. A GFR less than 60 ml/min/1.73 m2 was found in 45.0% (27/60) of those with RMD compared with 12.8% (6/47) of those without RMD (odds ratio, 5.6; 95% confidence interval, 2.1-15). Multivariate logistic regression indicated that low GFR was a significant predictor for RMD, even after accounting for differences in age, diabetes, hypertension, hyperlipidemia, and other potential confounders. When comparing within classification subsets for RMD and GFR in patients with choroidal thickness data, significant choroidal thinning was associated with RMD (170 vs. 228 μm; P = 0.01) and GFR less than 60 ml/min/1.73 m2 (144 vs. 219 μm; P = 0.0008). CONCLUSIONS Our analysis showed an association between RMD and renal dysfunction. Larger cross-sectional and longitudinal studies of the association of RMD with kidney function are warranted to better understand the nature and biological basis of this observed connection.
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Affiliation(s)
- Heather B Leisy
- Department of Ophthalmology, New York University School of Medicine, New York, New York.
| | - Meleha Ahmad
- Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - Michael Marmor
- Departments of Population Health, Environmental Medicine, and Medicine, New York University School of Medicine, New York, New York
| | - R Theodore Smith
- Department of Ophthalmology, New York University School of Medicine, New York, New York
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14
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Caplan-Shaw C, Kazeros A, Pradhan D, Berger K, Goldring R, Zhao S, Liu M, Shao Y, Fernandez-Beros ME, Marmor M, Levy-Carrick N, Rosen R, Ferri L, Reibman J. Improvement in severe lower respiratory symptoms and small airway function in World Trade Center dust exposed community members. Am J Ind Med 2016; 59:777-87. [PMID: 27582480 DOI: 10.1002/ajim.22642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Longitudinal assessment of lower respiratory symptoms (LRS) in community members with World Trade Center (WTC) exposures. METHODS Adult members of a treatment program with complete standardized visits were evaluated (n = 798). Association of demographic characteristics, mental health symptoms and lung function with trajectory of LRS between initial and monitoring visit was evaluated. RESULTS Severe LRS were present in 70% at initial and 63% at monitoring visit. Initial severe LRS were associated with WTC dust cloud exposure and mental health symptoms. Spirometry measures were not associated with LRS severity or trajectory; improvement in LRS was associated with improved lung function measured with forced oscillometry techniques. CONCLUSION Many community patients in a WTC treatment program had severe LRS associated with exposures and mental health symptoms. Improvement in LRS was associated with improvement in measures of small airway function. Am. J. Ind. Med. 59:777-787, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Caralee Caplan-Shaw
- Department of Medicine; New York University Langone Medical Center; New York City New York
| | - Angeliki Kazeros
- Department of Medicine; New York University Langone Medical Center; New York City New York
| | - Deepak Pradhan
- Department of Medicine; New York University Langone Medical Center; New York City New York
| | - Kenneth Berger
- Department of Medicine; New York University Langone Medical Center; New York City New York
| | - Roberta Goldring
- Department of Medicine; New York University Langone Medical Center; New York City New York
| | - Sibo Zhao
- Department of Population Health; New York University Langone Medical Center; New York City New York
- Department of Environmental Medicine; New York University Langone Medical Center; New York City New York
| | - Mengling Liu
- Department of Population Health; New York University Langone Medical Center; New York City New York
- Department of Environmental Medicine; New York University Langone Medical Center; New York City New York
| | - Yongzhao Shao
- Department of Population Health; New York University Langone Medical Center; New York City New York
- Department of Environmental Medicine; New York University Langone Medical Center; New York City New York
| | | | - Michael Marmor
- Department of Population Health; New York University Langone Medical Center; New York City New York
- Department of Environmental Medicine; New York University Langone Medical Center; New York City New York
| | - Nomi Levy-Carrick
- Department of Psychiatry; New York University Langone Medical Center; New York City New York
| | - Rebecca Rosen
- Department of Psychiatry; New York University Langone Medical Center; New York City New York
| | - Lucia Ferri
- Department of Psychiatry; New York University Langone Medical Center; New York City New York
| | - Joan Reibman
- Department of Medicine; New York University Langone Medical Center; New York City New York
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15
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Berger KI, Kalish S, Shao Y, Marmor M, Kazeros A, Oppenheimer BW, Chan Y, Reibman J, Goldring RM. Isolated small airway reactivity during bronchoprovocation as a mechanism for respiratory symptoms in WTC dust-exposed community members. Am J Ind Med 2016; 59:767-76. [PMID: 27582479 DOI: 10.1002/ajim.22639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Small airway dysfunction occurs following WTC dust exposure, but its role in producing symptoms is unclear. METHODS Methacholine challenge (MCT) was used to assess the relationship between onset of respiratory symptoms and small airway abnormalities in 166 symptomatic WTC dust-exposed patients. Forced oscillation testing (FOT) and respiratory symptoms were assessed during MCT. FOT parameters included resistance at 5 and 20 Hz (R5 and R20 ) and the R5 minus R20 (R5-20 ). RESULTS Baseline spirometry was normal in all (mean FEV1 100 + 13% predicted, mean FEV1 /FVC 80 + 4%). MCT revealed bronchial hyperreactivity by spirometry in 67 patients. An additional 24 patients became symptomatic despite minimal FEV1 change (<5%); symptom onset coincided with increased R5 and R5-20 (P > 0.001 vs. baseline). The dose-response of FOT (reactivity) was greater compared with subjects that remained asymptomatic (P < 0.05). CONCLUSIONS FOT during MCT uncovered reactivity in small airways as a mechanism for respiratory symptoms in subjects with inhalational lung injury. Am. J. Ind. Med. 59:767-776, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kenneth I. Berger
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
| | - Samantha Kalish
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
| | - Yongzhao Shao
- Department of Population Health; NYU School of Medicine; New York New York
| | - Michael Marmor
- Department of Population Health; NYU School of Medicine; New York New York
| | - Angeliki Kazeros
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
| | - Beno W. Oppenheimer
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
| | - Yinny Chan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
| | - Joan Reibman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
| | - Roberta M. Goldring
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
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16
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Jones BW, Pfeiffer RL, Ferrell WD, Watt CB, Marmor M, Marc RE. Retinal remodeling in human retinitis pigmentosa. Exp Eye Res 2016; 150:149-65. [PMID: 27020758 DOI: 10.1016/j.exer.2016.03.018] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/23/2016] [Accepted: 03/18/2016] [Indexed: 12/11/2022]
Abstract
Retinitis Pigmentosa (RP) in the human is a progressive, currently irreversible neural degenerative disease usually caused by gene defects that disrupt the function or architecture of the photoreceptors. While RP can initially be a disease of photoreceptors, there is increasing evidence that the inner retina becomes progressively disorganized as the outer retina degenerates. These alterations have been extensively described in animal models, but remodeling in humans has not been as well characterized. This study, using computational molecular phenotyping (CMP) seeks to advance our understanding of the retinal remodeling process in humans. We describe cone mediated preservation of overall topology, retinal reprogramming in the earliest stages of the disease in retinal bipolar cells, and alterations in both small molecule and protein signatures of neurons and glia. Furthermore, while Müller glia appear to be some of the last cells left in the degenerate retina, they are also one of the first cell classes in the neural retina to respond to stress which may reveal mechanisms related to remodeling and cell death in other retinal cell classes. Also fundamentally important is the finding that retinal network topologies are altered. Our results suggest interventions that presume substantial preservation of the neural retina will likely fail in late stages of the disease. Even early intervention offers no guarantee that the interventions will be immune to progressive remodeling. Fundamental work in the biology and mechanisms of disease progression are needed to support vision rescue strategies.
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Affiliation(s)
- B W Jones
- Dept. Ophthalmology, Moran Eye Center, University of Utah, USA.
| | - R L Pfeiffer
- Dept. Ophthalmology, Moran Eye Center, University of Utah, USA
| | - W D Ferrell
- Dept. Ophthalmology, Moran Eye Center, University of Utah, USA
| | - C B Watt
- Dept. Ophthalmology, Moran Eye Center, University of Utah, USA
| | - M Marmor
- Dept. Ophthalmology, Stanford University, USA
| | - R E Marc
- Dept. Ophthalmology, Moran Eye Center, University of Utah, USA
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Berger KI, Turetz M, Liu M, Shao Y, Kazeros A, Parsia S, Caplan-Shaw C, Friedman SM, Maslow CB, Marmor M, Goldring RM, Reibman J. Oscillometry complements spirometry in evaluation of subjects following toxic inhalation. ERJ Open Res 2015; 1:00043-2015. [PMID: 27730155 PMCID: PMC5005120 DOI: 10.1183/23120541.00043-2015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/12/2015] [Indexed: 01/02/2023] Open
Abstract
The World Trade Center (WTC) destruction released dust and fumes into the environment. Although many community members developed respiratory symptoms, screening spirometry was usually normal. We hypothesised that forced oscillation testing would identify functional abnormalities undetected by spirometry and that symptom severity would relate to magnitude of abnormalities measured by oscillometry. A symptomatic cohort (n=848) from the Bellevue Hospital WTC Environmental Health Center was evaluated and compared to an asymptomatic cohort (n=475) from the New York City Department of Health WTC Health Registry. Spirometry and oscillometry were performed. Oscillometry measurements included resistance (R5) and frequency dependence of resistance (R5-20). Spirometry was normal for the majority of subjects (73.2% symptomatic versus 87.6% asymptomatic, p<0.0001). In subjects with normal spirometry, R5 and R5-20 were higher in symptomatic versus asymptomatic subjects (median (interquartile range) R5 0.436 (0.206) versus 0.314 (0.129) kPa·L-1·s-1, p<0.001; R5-20 0.075 (0.085) versus 0.004 (0.042) kPa·L-1·s-1, p<0.0001). In symptomatic subjects, R5 and R5-20 increased with increasing severity and frequency of wheeze (p<0.05). Measurement of R5-20 correlated with the presence and severity of symptoms even when spirometry was within normal limits. These findings are in accord with small airway abnormalities as a potential explanation of the respiratory symptoms.
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Affiliation(s)
- Kenneth I Berger
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, NY, USA; André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA; These authors contributed equally to this manuscript
| | - Meredith Turetz
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, NY, USA; These authors contributed equally to this manuscript
| | - Mengling Liu
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Angeliki Kazeros
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Sam Parsia
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Caralee Caplan-Shaw
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Stephen M Friedman
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Carey B Maslow
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Michael Marmor
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Roberta M Goldring
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, NY, USA; André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Joan Reibman
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, NY, USA
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Silvera RJ, Grov C, Stein DJ, Hagerty R, Marmor M. Level of ‘outness’ and pornography use among men who have sex with men: results from an online survey. Psychology & Sexuality 2014. [DOI: 10.1080/19419899.2014.984907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Saade C, Ganti B, Marmor M, Freund KB, Smith RT. Risk characteristics of the combined geographic atrophy and choroidal neovascularisation phenotype in age-related macular degeneration. Br J Ophthalmol 2014; 98:1729-32. [PMID: 25091949 DOI: 10.1136/bjophthalmol-2014-305005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 10/24/2022]
Abstract
AIM To investigate the risk characteristics of the combined geographic atrophy (GA) and choroidal neovascularisation (CNV) phenotype of age-related macular degeneration (AMD) compared to GA or CNV. METHODS Patients with advanced AMD were identified and divided into three groups using multimodal imaging: patients with GA in at least one eye, patients with CNV in at least one eye, and patients with simultaneous GA and CNV in at least one eye. Epidemiologic and clinical factors were gathered from patient questionnaires. Genotypes for age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH) were determined. RESULTS 42 patients with GA or CNV, and 16 patients with combined GA/CNV were identified. Patients with the combined phenotype were older (86.4 vs 81.8 years, p=0.049), and had a higher prevalence of advanced AMD in the fellow eye (81.3% vs 31.0%, p<0.001). CFH and ARMS2 risk alleles were not associated with the combined phenotype. CONCLUSIONS The combined GA/CNV phenotype has similar epidemiologic, clinical, and genetic features as GA and CNV, but occurs at an older age and is more associated with advanced AMD in the fellow eye, suggesting that all these phenotypes are part of the same spectrum of disease and that the combined phenotype represents an even more advanced form of AMD than either GA or CNV.
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Affiliation(s)
- Celine Saade
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Bhaskar Ganti
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Michael Marmor
- Department of Population Health, New York University School of Medicine, New York, New York, USA Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - K Bailey Freund
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA Department of Ophthalmology, Columbia University, New York, New York, USA Vitreous Retina Macula Consultants of New York, New York, New York, USA LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA
| | - R Theodore Smith
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
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Boddu S, Lee MD, Marsiglia M, Marmor M, Freund KB, Smith RT. Risk factors associated with reticular pseudodrusen versus large soft drusen. Am J Ophthalmol 2014; 157:985-993.e2. [PMID: 24491417 DOI: 10.1016/j.ajo.2014.01.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate genetic, environmental, and systemic risk factors in prospectively identified subjects with the age-related macular degeneration (AMD) phenotypes of (1) reticular pseudodrusen without large soft drusen and (2) large soft drusen without reticular pseudodrusen. DESIGN Prospective case-case comparison. METHODS In a clinical practice setting, patients with AMD were sequentially screened using clinical examination and scanning laser ophthalmoscopy imaging to prospectively identify subjects (n = 73) with the phenotypes of (1) reticular pseudodrusen without large soft drusen (n = 30) or (2) large soft drusen without reticular pseudodrusen (n = 43). Subjects were genotyped for 2 alleles associated with AMD, age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH). A questionnaire was administered to collect history of smoking, hypertension, diabetes, and hyperlipidemia, as well as personal and family history of AMD. RESULTS The reticular pseudodrusen group was older (median age 87 vs 81 years, P = .04) and had more female subjects (83.3% vs 48.8%, P = .003), later ages of AMD onset (83 vs 70 years, P = .0005), and a greater frequency of hypertension (76.7% vs 55.8%, P = .08). No significant differences were found in the distribution of the ARMS2 risk allele (P = .4) between the reticular pseudodrusen (homozygous = 20.0%; heterozygous = 56.7%) and large soft drusen (homozygous = 19.0%; heterozygous = 42.9%) phenotypes, or in the distribution of the CHF risk allele (P = .7) between the reticular pseudodrusen (homozygous = 26.7%; heterozygous = 56.7%) and large soft drusen (homozygous = 21.4%; heterozygous = 66.7%) phenotypes. CONCLUSIONS The reticular pseudodrusen phenotype was associated with increased age, later age of AMD onset, and female sex.
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Lavinsky D, Chalberg TW, Mandel Y, Huie P, Dalal R, Marmor M, Palanker D. Modulation of Transgene Expression in Retinal Gene Therapy by Selective Laser Treatment. ACTA ACUST UNITED AC 2013; 54:1873-80. [DOI: 10.1167/iovs.12-10933] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Yossi Mandel
- From the Department of Ophthalmology and the 2Hansen Experimental Physics Laboratory, Stanford University, Stanford, California; the
| | - Philip Huie
- From the Department of Ophthalmology and the 2Hansen Experimental Physics Laboratory, Stanford University, Stanford, California; the
| | - Roopa Dalal
- From the Department of Ophthalmology and the
| | | | - Daniel Palanker
- From the Department of Ophthalmology and the 2Hansen Experimental Physics Laboratory, Stanford University, Stanford, California; the
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Drexler M, Dwyer T, Marmor M, Abolghasemian M, Sternheim A, Cameron HU. Cementless fixation in total knee arthroplasty: down the boulevard of broken dreams - opposes. ACTA ACUST UNITED AC 2013; 94:85-9. [PMID: 23118390 DOI: 10.1302/0301-620x.94b11.30827] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In this study we present our experience with four generations of uncemented total knee arthroplasty (TKA) from Smith & Nephew: Tricon M, Tricon LS, Tricon II and Profix, focusing on the failure rates correlating with each design change. Beginning in 1984, 380 Tricon M, 435 Tricon LS, 305 Tricon 2 and 588 Profix were implanted by the senior author. The rate of revision for loosening was 1.1% for the Tricon M, 1.1% for the Tricon LS, 0.5% for the Tricon 2 with a HA coated tibial component, and 1.3% for the Profix TKA. No loosening of the femoral component was seen with the Tricon M, Tricon LS or Tricon 2, with no loosening seen of the tibial component with the Profix TKA. Regarding revision for wear, the incidence was 13.1% for the Tricon M, 6.6% for the Tricon LS, 2.3% for the Tricon 2, and 0% for the Profix. These results demonstrate that improvements in the design of uncemented components, including increased polyethylene thickness, improved polyethylene quality, and the introduction of hydroxyapatite coating, has improved the outcomes of uncemented TKA over time.
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Affiliation(s)
- M Drexler
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Holland Orthopaedic & Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario M4Y 1H1, Canada.
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23
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Stein DJ, Silvera RJ, Hagerty R, Marmor M. Viewing pornography depicting unprotected anal intercourse: are there implications for HIV prevention among men who have sex with men? Arch Sex Behav 2012; 41:411-9. [PMID: 21755381 PMCID: PMC3310969 DOI: 10.1007/s10508-011-9789-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 05/27/2011] [Accepted: 05/29/2011] [Indexed: 05/19/2023]
Abstract
We used an Internet-based questionnaire to investigate whether viewing pornography depicting unprotected anal intercourse (UAI) was associated with engaging in UAI in a sample of 821 non-monogamous men who have sex with men (MSM). In the 3 months prior to interview, 77.2% viewed pornography depicting UAI, 42.6% engaged in insertive UAI, and 38.9% engaged in receptive UAI. Polytomous logistic regression of the 751 subjects who provided data on pornography viewing showed significantly elevated odds ratios for having engaged in receptive UAI, insertive UAI, and both receptive and insertive UAI associated with increasing percentage of pornography viewed that depicted UAI. We also found independently significant associations of engaging in UAI with age, use of inhalant nitrites, and HIV status. Although the data cannot establish causality, our findings indicate that viewing pornography depicting UAI and engaging in UAI are correlated. Further research is needed to determine if this observation may have utility for HIV prevention.
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Affiliation(s)
- Dylan J Stein
- Department of Environmental Medicine, NYU School of Medicine, New York, NY
- Center for AIDS Research, NYU School of Medicine, New York, NY
| | - Richard J Silvera
- Department of Environmental Medicine, NYU School of Medicine, New York, NY
- Center for AIDS Research, NYU School of Medicine, New York, NY
| | - Robert Hagerty
- Department of Environmental Medicine, NYU School of Medicine, New York, NY
- Center for AIDS Research, NYU School of Medicine, New York, NY
| | - Michael Marmor
- Department of Environmental Medicine, NYU School of Medicine, New York, NY
- Center for AIDS Research, NYU School of Medicine, New York, NY
- Department of Medicine, NYU School of Medicine, New York, NY
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Udar N, Small K, Chalukya M, Silva-Garcia R, Marmor M. Developmental or degenerative--NR2E3 gene mutations in two patients with enhanced S cone syndrome. Mol Vis 2011; 17:519-25. [PMID: 21364904 PMCID: PMC3044695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 02/14/2011] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Enhanced S Cone Syndrome is a rare autosomal recessive disorder characterized clinically by an absence of rod function, a replacement of most L and M cone function by S cone activity (Goldmann-Favre Syndrome) and by variable degrees of retinal degeneration in different families. The causative gene, nuclear receptor subfamily 2, group E, member 3 (NR2E3), controls the developmental sequence for rods and cones. The purpose of this study was to compare the nature and implications of mutations in two subjects with Enhanced S Cone Syndrome who have significantly different degrees of degenerative damage. METHODS A direct sequencing approach was used to identify the mutations. Genomic DNA was amplified from all the exons of NR2E3 and used as a template for sequencing. Of the two families studied, Case 1 is of Persian ethnicity while Case 2 is Brazilian. A total of six individuals within the two families were studied. RESULTS Case 1 (original propositus of the syndrome) has the characteristic developmental rod/cone abnormality with large amplitude electroretinogram responses and no retinal degeneration. She was homozygous for a novel mutation, c.[del196-201del6] (p.G66-C67del), which lies entirely within the P-box for this gene. By comparison, Case 2 had Goldmann-Favre Syndrome with retinal degeneration and low electroretinogram signals. She was a compound heterozygote for c.[119-2A>C]+[del194-202del9] (p.N65-C67del), mutations that have been reported previously. Her second mutation overlaps that of Case 1 within the P-box. CONCLUSIONS The novel in-frame homozygous deletion of Case 1, within the P-box motif of the DNA binding domain, caused a developmental abnormality without retinal degeneration. Case 2, with more traditional Goldmann-Favre Syndrome with retinal degeneration, was a compound heterozygote where one allele had a similar P-box deletion but the other was a splicing defect. Case 1 is the first reported homozygous deletion within the P-box. This is the first report of NR2E3 mutations in a Persian and a Brazilian family.
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Affiliation(s)
- Nitin Udar
- Department of Ophthalmology, University of California Irvine, Irvine, CA
| | - Kent Small
- Molecular Insight LLC, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Meenal Chalukya
- Department of Hematology and Oncology, University of California Los Angeles, Los Angeles, CA
| | | | - Michael Marmor
- Department of Ophthalmology, Stanford University Medical Center, Stanford, CA
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Silvera R, Stein D, Hutt R, Hagerty R, Daskalakis D, Valentine F, Marmor M. The Development and Implementation of an Outreach Program to Identify Acute and Recent HIV Infections in New York City. Open AIDS J 2010; 4:76-83. [PMID: 20386719 PMCID: PMC2852119 DOI: 10.2174/1874613601004010076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 08/11/2009] [Accepted: 09/16/2009] [Indexed: 11/22/2022] Open
Abstract
Introduction: Since 2004, the authors have been operating First Call NYU, an outreach program to identify acute and recent HIV infections, also called primary HIV infections, among targeted at-risk communities in the New York City (NYC) metropolitan area. Materials and Methodology: First Call NYU employed mass media advertising campaigns, outreach to healthcare providers in NYC, and Internet-based efforts including search engine optimization (SEO) and Internet-based advertising to achieve these goals. Results: Between October 2004 and October 2008, 571 individuals were screened through this program, leading to 446 unique, in-person screening visits. 47 primary HIV infections, including 14 acute and 33 recent HIV infections, were identified. Discussion: Internet and traditional recruitment methods can be used to increase self-referrals for screening following possible exposure to HIV. Conclusion: Community education of at-risk groups, with the goal of increased self-diagnosis of possible acute HIV infection, may be a useful addition to traditional efforts to identify such individuals.
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Affiliation(s)
- Richard Silvera
- Department of Environmental Medicine, NYU School of Medicine, New York, NY, USA
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Daskalakis D, Silvera R, Bernstein K, Stein D, Hagerty R, Hutt R, Maillard A, Borkowsky W, Aberg J, Valentine F, Marmor M. Implementation of HIV testing at 2 New York City bathhouses: from pilot to clinical service. Clin Infect Dis 2009; 48:1609-16. [PMID: 19400690 DOI: 10.1086/598979] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Commercial sex venues (e.g., bathhouses) that cater to men who have sex with men (MSM) continue to function in most urban areas. These venues present a challenge to developing strategies to prevent the spread of the human immunodeficiency virus (HIV), but they also provide opportunities for interventions to reduce the risk and rate of disease transmission. Several cities in the United States have developed programs that offer HIV testing in these venues. Similar programs have not existed before in New York City. METHODS A pilot HIV testing program was implemented at 2 New York City bathhouses. Testing included rapid HIV testing, the use of the serologic testing algorithm for recent HIV seroconversion, and pooled plasma HIV viral load to detect and date incident and acute HIV infections. In addition to HIV tests, behavioral and demographic data were collected from 493 presumed HIV-negative participants. RESULTS The pilot program recruited MSM who were at high risk for HIV infection. Of the 493 men tested, 20 (4%) were found to be positive for HIV, and 8 (40%) of these 20 men demonstrated evidence of acute or recent HIV infection. The program tested men often not tested in more traditional medical settings. Significant disparities were demonstrated in the testing habits of MSM who reported having sex with women and had not disclosed same-sex activities to their caregivers. CONCLUSIONS Bathhouse-based testing for HIV infection can be implemented in New York City and would include a population of MSM who are at high risk for HIV infection. Because of the high rate of recent HIV infection, expanded testing in these venues may be a good strategy to reduce the forward transmission of HIV in this highly sexually active population.
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Affiliation(s)
- Demetre Daskalakis
- Division of Infectious Diseases and Immunology, New York University Langone Medical Center, New York, New York 10016, USA.
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Reibman J, Marmor M, Filner J, Fernandez-Beros ME, Rogers L, Perez-Perez GI, Blaser MJ. Asthma is inversely associated with Helicobacter pylori status in an urban population. PLoS One 2008; 3:e4060. [PMID: 19112508 PMCID: PMC2603593 DOI: 10.1371/journal.pone.0004060] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 11/28/2008] [Indexed: 12/12/2022] Open
Abstract
Background Microbial exposures have been suggested to confer protection from allergic disorders and reduced exposures to gastrointestinal microbiota have been proposed as an explanation for the increase in asthma prevalence. Since the general prevalence of Helicobacter pylori has been decreasing, we hypothesized that H. pylori serostatus would be inversely related to the presence of asthma. Methods Adults were recruited to participate in the New York University (NYU)/Bellevue Asthma Registry in New York City. Adult asthma cases (N = 318) and controls (N = 208) were identified and serum IgG antibodies to H. pylori whole cell antigens or the immunodominant CagA antigen were measured. Results As expected, the asthma cases and controls differed with respect to atopy and lung function. Seropositivity to H. pylori or CagA antigen was present in 47.1% of the total case and control study population. Asthma was inversely associated with CagA seropositivity (OR = 0.57, 95% CI = 0.36–0.89). Median age of onset of asthma (doctor's diagnosis) was older (21 years) among individuals with CagA+ strains than among H. pylori- individuals (11 years) (p = 0.006). Conclusion These data are consistent with the hypothesis that colonization with CagA+ H. pylori strains is inversely associated with asthma and is associated with an older age of asthma onset in an urban population. The data suggest H. pylori as a marker for protection. Trial Registration ClinicalTrials.gov NCT00212537
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Affiliation(s)
- Joan Reibman
- Department of Medicine, New York University School of Medicine, New York City, New York, USA.
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Paulus YM, Jain AT, Gariano RF, Stanzel BV, Marmor M, Blumenkranz MS, Palanker D. Healing of Retinal Photocoagulation Lesions. ACTA ACUST UNITED AC 2008; 49:5540-5. [DOI: 10.1167/iovs.08-1928] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [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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Buchbinder SP, Mehrotra DV, Duerr A, Fitzgerald DW, Mogg R, Li D, Gilbert PB, Lama JR, Marmor M, Del Rio C, McElrath MJ, Casimiro DR, Gottesdiener KM, Chodakewitz JA, Corey L, Robertson MN. Efficacy assessment of a cell-mediated immunity HIV-1 vaccine (the Step Study): a double-blind, randomised, placebo-controlled, test-of-concept trial. Lancet 2008; 372:1881-1893. [PMID: 19012954 PMCID: PMC2721012 DOI: 10.1016/s0140-6736(08)61591-3] [Citation(s) in RCA: 1320] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Observational data and non-human primate challenge studies suggest that cell-mediated immune responses might provide control of HIV replication. The Step Study directly assessed the efficacy of a cell-mediated immunity vaccine to protect against HIV-1 infection or change in early plasma HIV-1 levels. METHODS We undertook a double-blind, phase II, test-of-concept study at 34 sites in North America, the Caribbean, South America, and Australia. We randomly assigned 3000 HIV-1-seronegative participants by computer-generated assignments to receive three injections of MRKAd5 HIV-1 gag/pol/nef vaccine (n=1494) or placebo (n=1506). Randomisation was prestratified by sex, adenovirus type 5 (Ad5) antibody titre at baseline, and study site. Primary objective was a reduction in HIV-1 acquisition rates (tested every 6 months) or a decrease in HIV-1 viral-load setpoint (early plasma HIV-1 RNA measured 3 months after HIV-1 diagnosis). Analyses were per protocol and modified intention to treat. The study was stopped early because it unexpectedly met the prespecified futility boundaries at the first interim analysis. This study is registered with ClinicalTrials.gov, number NCT00095576. FINDINGS In a prespecified interim analysis in participants with baseline Ad5 antibody titre 200 or less, 24 (3%) of 741 vaccine recipients became HIV-1 infected versus 21 (3%) of 762 placebo recipients (hazard ratio [HR] 1.2 [95% CI 0.6-2.2]). All but one infection occurred in men. The corresponding geometric mean plasma HIV-1 RNA was comparable in infected male vaccine and placebo recipients (4.61 vs 4.41 log(10) copies per mL, one tailed p value for potential benefit 0.66). The vaccine elicited interferon-gamma ELISPOT responses in 75% (267) of the 25% random sample of all vaccine recipients (including both low and high Ad5 antibody titres) on whose specimens this testing was done (n=354). In exploratory analyses of all study volunteers, irrespective of baseline Ad5 antibody titre, the HR of HIV-1 infection between vaccine and placebo recipients was higher in Ad5 seropositive men (HR 2.3 [95% CI 1.2-4.3]) and uncircumcised men (3.8 [1.5-9.3]), but was not increased in Ad5 seronegative (1.0 [0.5-1.9]) or circumcised (1.0 [0.6-1.7]) men. INTERPRETATION This cell-mediated immunity vaccine did not prevent HIV-1 infection or reduce early viral level. Mechanisms for insufficient efficacy of the vaccine and the increased HIV-1 infection rates in subgroups of vaccine recipients are being explored.
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Affiliation(s)
- Susan P Buchbinder
- HIV Research Section, San Francisco Department of Public Health, San Francisco, CA, USA.
| | | | - Ann Duerr
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel W Fitzgerald
- GHESKIO, Port-au-Prince, Haiti; Weill Medical College of Cornell University, New York, NY, USA
| | - Robin Mogg
- Merck Research Laboratories, North Wales, PA, USA
| | - David Li
- Merck Research Laboratories, North Wales, PA, USA
| | | | - Javier R Lama
- Asociacion Civil IMPACTA Salud y Educacion, Miraflores, Lima, Peru
| | | | | | | | | | | | | | - Lawrence Corey
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Butterwick A, Huie P, Jones BW, Marc RE, Marmor M, Palanker D. Effect of shape and coating of a subretinal prosthesis on its integration with the retina. Exp Eye Res 2008; 88:22-9. [PMID: 18955050 DOI: 10.1016/j.exer.2008.09.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 09/09/2008] [Accepted: 09/13/2008] [Indexed: 10/21/2022]
Abstract
Retinal stimulation with high spatial resolution requires close proximity of electrodes to target cells. This study examines the effects of material coatings and 3-dimensional geometries of subretinal prostheses on their integration with the retina. A trans-scleral implantation technique was developed to place microfabricated structures in the subretinal space of RCS rats. The effect of three coatings (silicon oxide, iridium oxide and parylene) and three geometries (flat, pillars and chambers) on the retinal integration was compared using passive implants. Retinal morphology was evaluated histologically 6 weeks after implantation. For 3-dimensional implants the retinal cell phenotype was also evaluated using Computational Molecular Phenotyping. Flat implants coated with parylene and iridium oxide were generally well tolerated in the subretinal space, inducing only a mild gliotic response. However, silicon-oxide coatings induced the formation of a significant fibrotic seal around the implants. Glial proliferation was observed at the base of the pillar electrode arrays and inside the chambers. The non-traumatic penetration of pillar tips into the retina provided uniform and stable proximity to the inner nuclear layer. Retinal cells migrated into chambers with apertures larger than 10 mum. Both pillars and chambers achieved better proximity to the inner retinal cells than flat implants. However, isolation of retinal cells inside the chamber arrays is likely to affect their long-term viability. Pillars demonstrated minimal alteration of the inner retinal architecture, and thus appear to be the most promising approach for maintaining close proximity between the retinal prosthetic electrodes and target neurons.
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Affiliation(s)
- A Butterwick
- Stanford University, Department of Applied Physics, Stanford, CA 94305, USA
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Priddy FH, Brown D, Kublin J, Monahan K, Wright DP, Lalezari J, Santiago S, Marmor M, Lally M, Novak RM, Brown SJ, Kulkarni P, Dubey SA, Kierstead LS, Casimiro DR, Mogg R, DiNubile MJ, Shiver JW, Leavitt RY, Robertson MN, Mehrotra DV, Quirk E. Safety and immunogenicity of a replication-incompetent adenovirus type 5 HIV-1 clade B gag/pol/nef vaccine in healthy adults. Clin Infect Dis 2008; 46:1769-81. [PMID: 18433307 DOI: 10.1086/587993] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The safety and immunogenicity of the MRK adenovirus type 5 human immunodeficiency virus type 1 clade B gag/pol/nef vaccine, a replication-incompetent adenovirus type 5-vectored vaccine designed to elicit cell-mediated immunity against conserved human immunodeficiency virus proteins, was assessed in a phase 1 trial. METHODS Healthy adults not infected with human immunodeficiency virus were enrolled in a multicenter, dose-escalating, blind, placebo-controlled study to evaluate a 3-dose homologous prime-boost regimen of the trivalent MRK adenovirus type 5 human immunodeficiency virus type 1 vaccine containing from 3 x 10(6) to 1 x 10(11) viral particles per 1-mL dose administered on day 1, during week 4 and during week 26. Adverse events were recorded for 29 days after each intradeltoid injection. The primary immunogenicity end point was the proportion of study participants with a positive unfractionated Gag-, Pol-, or Nef-specific interferon-gamma enzyme-linked immunosorbent spot response measured 4 weeks after administration of the last dose. RESULTS Of 259 randomized individuals, 257 (99%) received > or = 1 dose of vaccine or placebo and were included in the safety analyses. Enzyme-linked immunosorbent spot results were available for 217 study participants (84%) at week 30. No serious vaccine-related adverse events occurred. No study participant discontinued participation because of vaccine-related adverse events. The frequency of injection-site reactions was dose dependent. Vaccine doses of > or = 3 x 10(9) viral particles elicited positive enzyme-linked immunosorbent spot responses to > or = 1 vaccine component in > 60% of recipients. High baseline antibody titers against adenovirus type 5 diminished enzyme-linked immunosorbent spot responses at all doses except the 3 x 10(10) viral particle dose. CONCLUSIONS The vaccine was generally well tolerated and induced cell-mediated immune responses against human immunodeficiency virus type 1 peptides in most healthy adults. Despite these findings, vaccination in a proof-of-concept trial with use of this vaccine was discontinued because of lack of efficacy.
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Affiliation(s)
- Frances H Priddy
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
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Nilforoushan MR, Speaker M, Marmor M, Abramson J, Tullo W, Morschauser D, Latkany R. Comparative evaluation of refractive surgery candidates with Placido topography, Orbscan II, Pentacam, and wavefront analysis. J Cataract Refract Surg 2008; 34:623-31. [DOI: 10.1016/j.jcrs.2007.11.054] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 11/24/2007] [Indexed: 10/22/2022]
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Marmor M, Belitskaya-Lévy I, Arslan AA. Re: Letter to the editor on "Bias in clinical intervention research". Am J Epidemiol 2008; 167:500-1; author reply 501-2. [PMID: 18156601 DOI: 10.1093/aje/kwm372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marmor M. Re: "Motor vehicle crash injury rates by mode of travel, United States: using exposure-based methods to quantify differences". Am J Epidemiol 2007; 166:1356; author reply 1356-7. [PMID: 17925282 DOI: 10.1093/aje/kwm286] [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: 11/14/2022] Open
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Ritterband DC, Shapiro D, Trubnik V, Marmor M, Meskin S, Seedor J, Liebmann JM, Tello C, Koplin R, Harizman N, Shabto U, Ritch R. Penetrating Keratoplasty With Pars Plana Glaucoma Drainage Devices. Cornea 2007; 26:1060-6. [PMID: 17893534 DOI: 10.1097/ico.0b013e3181342835] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [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: 11/26/2022]
Abstract
PURPOSE To study the outcome of penetrating keratoplasty (PK) in eyes undergoing simultaneous insertion or repositioning of a glaucoma drainage device (GDD) through the pars plana. METHODS The medical records of all patients who underwent PK and primary placement or repositioning of a GDD through the pars plana from April 1, 1997, through December 1, 2005, were reviewed. Intraocular pressure (IOP) control was defined as maintenance of IOP > or = 5 and < or = 21 mm Hg (without loss of light perception vision or needing further glaucoma surgery). Kaplan-Meier life table survival analysis was used to estimate the success of graft survival (clarity) and glaucoma control. RESULTS Eighty-three eyes of 80 patients (34 men and 46 women) were identified. Mean follow-up was 16 months (range, 6-96 months). PK and pars plana vitrectomy were performed with primary pars plana GDD insertion (57 eyes) or tube repositioning from the anterior chamber to pars plana (26 eyes). Grafts remained clear in 93% of eyes (76/83) at 6 months, 87% (56/66) at 1 year, and 59% (19/32) at 2 years. IOP was controlled in 87% (72/83) of eyes at 6 months, 95% (57/63) at 1 year, and 83% (20/24) at 2 years. CONCLUSIONS PK with simultaneous pars plana GDD repositioning or placement showed comparable short- and long-term IOP control to that of previous studies with limbal-based GDD. The rate of corneal graft failure and the rate of immunologic rejection were comparable to or lower than those reported in other series with primary limbal-based GDD.
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Affiliation(s)
- David C Ritterband
- Department of Ophthalmology, New York Eye & Ear Infirmary, New York, NY 10003, USA.
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Marmor M, el-Sadr W, Zolla-Pazner S, Lazaro C, Stahl RE, William D. Immunologic abnormalities among male homosexuals in New York City: changes over time. Ann N Y Acad Sci 2006; 437:312-9. [PMID: 6241998 DOI: 10.1111/j.1749-6632.1984.tb37150.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
The Clinical Electro-oculogram (EOG) is an electrophysiological test of function of the outer retina and retinal pigment epithelium (RPE) in which the change in the electrical potential between the cornea and the ocular fundus is recorded during successive periods of dark and light adaptation. This document sets out a Standard Method for performance of the test, and also gives detailed guidance on technical and practical issues, and on reporting test results. The main object of the Standard is to promote consistent quality of testing and reporting within and between centres. This 2006 Standard, from the International Society for Clinical Electrophysiology of Vision (ISCEV: www.iscev.org ), is a revision of the previous Standard published in 1993, and reviewed and re-issued in 1998.
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Affiliation(s)
- Malcolm Brown
- Dept. of Clinical Engineering, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
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Abstract
OBJECTIVE To determine whether the ISNT rule (that normal eyes show a characteristic configuration for disc rim thickness of inferior > or = superior > or = nasal > or = temporal), widely used for clinical evaluation of the optic nerve head, can differentiate normal from glaucomatous eyes. METHODS All subjects underwent complete eye examination, including achromatic automated perimetry, simultaneous stereoscopic disc photography, and confocal scanning laser ophthalmoscopy. Subjects with normal eyes had no evidence of glaucoma or ocular hypertension and had normal perimetry measurements. Subjects with glaucoma had a reproducible visual field defect. One eye from each subject was randomly enrolled. The ISNT rule was assessed by masked evaluation of disc photographs at the 3, 6, 9, and 12 o'clock positions. RESULTS Sixty-six subjects with normal eyes (33 black and 33 white individuals) and 43 with open-angle glaucoma (15 black and 28 white individuals) were enrolled. The ISNT rule was intact in 52 (79%) of 66 normal eyes and 12 (28%) of 43 glaucomatous eyes (P<.001). Multiple logistic regression indicated that the odds ratio for glaucoma associated with violation of the ISNT rule was 6.04 (95% confidence interval, 1.74-20.95) after adjustment for age; race was not a confounder of this association. CONCLUSION The ISNT rule is useful in differentiating normal from glaucomatous optic nerves and is unaffected by race.
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Affiliation(s)
- Noga Harizman
- Department of Ophthalmology, The New York Eye and Ear Infirmary, New York University School of Medicine, New York, NY 10003, USA
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Thomas SM, Tse DB, Ketner DS, Rochford G, Meyer DA, Zade DD, Halkitis PN, Nádas A, Borkowsky W, Marmor M. CCR5 expression and duration of high risk sexual activity among HIV-seronegative men who have sex with men. AIDS 2006; 20:1879-83. [PMID: 16954729 PMCID: PMC1630600 DOI: 10.1097/01.aids.0000244207.49123.ff] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To test the hypothesis that in comparison with those with shorter risk duration, individuals with longer HIV risk duration would have reduced susceptibility to HIV-1 infection as measured by CCR5 expression, and to evaluate whether variation in CCR5 expression could be explained by known genetic polymorphisms. DESIGN AND METHODS A cross-sectional study of HIV-1 exposed but uninfected men who have sex with men. The risk duration was estimated from self-reported years since first receptive anal intercourse. CCR5 expression on peripheral blood CD4+ monocytes and T cells was determined by flow cytometry. The CCR5-Delta32 mutation and polymorphisms in the CCR5 promoter and CCR2 as well as the copy number of CCL3L1 were analyzed by polymerase chain reaction. Plasma levels of MIP-1alpha (CCL3), MIP-1beta (CCL4) and RANTES (CCL5) were also measured. As risk duration varied with age, analyses were restricted to 67 individuals aged 30-49 years. RESULTS Multiple linear regression analyses, adjusted for age and race, showed a significant negative association between HIV risk duration and CCR5 expression on monocytes (P = 0.01), and in a separate model, a similar negative association with CCR5 expression on T cells (P = 0.03). Low CCR5 expression was attributable mainly to CCR5-Delta32 heterozygosity and the CCR5-59029G allele. CONCLUSIONS We confirmed a role for reduced CCR5 expression in HIV-1 resistance. CCR5-Delta32 heterozygosity and the CCR5-59029G allele were significant predictors of low CCR5 expression. Individuals with high CCR5 expression who resisted infection despite long HIV risk duration form an interesting group within which to search for additional mechanisms of resistance to HIV infection.
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Affiliation(s)
- Susan M. Thomas
- From the Department of Environmental Medicine, New York University School of Medicine, New York, USA
- From the Center for AIDS Research, New York University School of Medicine, New York, USA
| | - Doris B. Tse
- From the Department of Medicine, New York University School of Medicine, New York, USA
- From the Center for AIDS Research, New York University School of Medicine, New York, USA
| | - D. Scott Ketner
- From the Department of Medicine, New York University School of Medicine, New York, USA
- From the Center for AIDS Research, New York University School of Medicine, New York, USA
| | - Gemma Rochford
- From the Center for AIDS Research, New York University School of Medicine, New York, USA
- From the Department of Pediatrics, New York University School of Medicine, New York, USA
| | - Daniel A. Meyer
- From the Department of Medicine, New York University School of Medicine, New York, USA
- From the Center for AIDS Research, New York University School of Medicine, New York, USA
| | - David D. Zade
- From the Department of Applied Psychology, Steinhardt School of Education, New York University, New York, USA
- From the Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Steinhardt School of Education, New York University, New York, USA
| | - Perry N. Halkitis
- From the Department of Applied Psychology, Steinhardt School of Education, New York University, New York, USA
- From the Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Steinhardt School of Education, New York University, New York, USA
| | - Arthur Nádas
- From the Department of Environmental Medicine, New York University School of Medicine, New York, USA
- From the Center for AIDS Research, New York University School of Medicine, New York, USA
| | - William Borkowsky
- From the Center for AIDS Research, New York University School of Medicine, New York, USA
- From the Department of Pediatrics, New York University School of Medicine, New York, USA
| | - Michael Marmor
- From the Department of Environmental Medicine, New York University School of Medicine, New York, USA
- From the Department of Medicine, New York University School of Medicine, New York, USA
- From the Center for AIDS Research, New York University School of Medicine, New York, USA
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Abstract
OBJECTIVES We investigated risk factors for fatal motor vehicle crashes on slippery roads in the Northeastern United States, 1998-2002. METHODS We analyzed data from the Fatality Analysis Reporting System of the National Highway Traffic Safety Administration. RESULTS Rates of crashes on slippery roads, and ratios of crashes on slippery roads to crashes on dry roads, were greatest among the youngest drivers. Among those aged 16 to 19 years, logistic regression analysis showed significant, independent risks associated with excessive speed for conditions (odds ratio [OR]=1.38), time of day (OR=1.80 for 5:00 to 9:00 am vs 10:00 am to 2:00 pm), time of year (OR=6.17 for January vs July), type of road (OR=1.27 for rural vs urban roads ), and age (OR=1.19 for those aged 16 to 17 years vs those aged 18 to 19 years). Licensure from states with graduated licensing programs was protective against crashes attributed to swerving on slippery roads (adjusted OR = 0.63). Risk factors among drivers older than 19 years were similar but peaked at different times of day and included increased risks for women compared with men. CONCLUSIONS Driver training programs need to better address hazards presented by slippery roads.
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Affiliation(s)
- Michael Marmor
- Department of Environmental Medicine, NYU School of Medicine, 650 First Avenue, Room 560, New York, NY 10016-3240, USA.
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Abstract
The biological correlates of an effective immune response that could contain or prevent HIV infection remain elusive despite substantial scientific accomplishments in understanding the interactions among the virus, the individual and the community. The observation that some individuals appear to possess resistance to HIV infection or its consequences has generated a host of epidemiologic investigations to identify biological or behavioral characteristics of these individuals. These data might hold the keys to developing appropriate strategies for mimicking the effective responses of those who appear immune. In this paper we review genetic mechanisms including the role of chemokines and their receptors, cytokines, host genetic immune response to HIV infection, local immune response correlating with behavioral variables, co-infection and immune based mechanisms that have been elucidated so far. We offer suggestions for how to use these observations as platforms for future research to further understand natural resistance to HIV infection through cohort studies, population genotype sampling, mathematical modeling of virus-host interactions and behavioral analyses.
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Affiliation(s)
- M Marmor
- Department of Environmental Medicine, New York University School of Medicine, 650 First Avenue, Room 560, New York, NY 10016, USA.
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