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Santoro GC, Shukla S, Patel K, Kaczmarzyk J, Agorastos S, Scherrer S, Choi YY, Veith C, Carrion J, Silverman R, Mullin D, Ahmed M, Schiffer WK, Brodie JD, Dewey SL. A Novel Strategy for Attenuating Opioid Withdrawal in Neonates. J Addict Res Ther 2017; 7. [PMID: 28078167 PMCID: PMC5222617 DOI: 10.4172/2155-6105.1000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The rate of Neonatal Abstinence Syndrome (NAS) has drastically increased over the past decade. The average hospital expense per NAS patient has tripled, while the number of babies born to opioid-dependent mothers has increased to 5 in 1000 births. Current treatment options are limited to opioid replacement and tapering. Consequently, we examined the efficacy of prenatal, low-dose and short-term vigabatrin (γ-vinyl GABA, GVG) exposure for attenuating these symptoms as well as the metabolic changes observed in the brains of these animals upon reaching adolescence. Pregnant Sprague-Dawley rats were treated in one of four ways: 1) saline; 2) morphine alone; 3) morphine+GVG at 25 mg/kg; 4) morphine+GVG at 50 mg/kg. Morphine was administered throughout gestation, while GVG administration occurred only during the last 5 days of gestation. On post-natal day 1, naloxone-induced withdrawal behaviours were recorded in order to obtain a gross behaviour score. Approximately 28 days following birth, 18FDG microPET scans were obtained on these same animals (Groups 1, 2, and 4). Morphine-treated neonates demonstrated significantly higher withdrawal scores than saline controls. However, GVG at 50 but not 25 mg/kg/day significantly attenuated them. Upon reaching adolescence, morphine treated animals showed regionally specific changes in 18FDG uptake. Again, prenatal GVG exposure blocked them. These data demonstrate that low-dose, short-term prenatal GVG administration blocks naloxone-induced withdrawal in neonates. Taken together, these preliminary findings suggest that GVG may provide an alternative and long-lasting pharmacologic approach for the management of neonatal and adolescent symptoms associated with NAS.
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Affiliation(s)
- Giovanni C Santoro
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Samarth Shukla
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA; Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA
| | - Krishna Patel
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Jakub Kaczmarzyk
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Stergiani Agorastos
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Sandra Scherrer
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Yoon Young Choi
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Christina Veith
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Joseph Carrion
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
| | - Rebecca Silverman
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Danielle Mullin
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Mohamed Ahmed
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA
| | - Wynne K Schiffer
- Department of Neurology, N. Bud Grossman Center for Memory Research and Care, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan D Brodie
- Psychiatry Department, New York University School of Medicine, NY, USA
| | - Stephen L Dewey
- Center for Neurosciences, Laboratory for Molecular and Behavioural Neuroimaging, Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA; Psychiatry Department, New York University School of Medicine, NY, USA
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Lerner RP, Bimpisidis Z, Agorastos S, Scherrer S, Dewey SL, Cenci MA, Eidelberg D. Dissociation of metabolic and hemodynamic levodopa responses in the 6-hydroxydopamine rat model. Neurobiol Dis 2016; 96:31-37. [PMID: 27544483 DOI: 10.1016/j.nbd.2016.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 06/20/2016] [Revised: 08/03/2016] [Accepted: 08/16/2016] [Indexed: 11/17/2022] Open
Abstract
Dissociation of vasomotor and metabolic responses to levodopa has been observed in human subjects with Parkinson's disease (PD) studied with PET and in autoradiograms from 6-hydroxydopamine (6-OHDA) rat. In both species, acute levodopa administration was associated with increases in basal ganglia cerebral blood flow (CBF) with concurrent reductions in cerebral metabolic rate (CMR) for glucose in the same brain regions. In this study, we used a novel dual-tracer microPET technique to measure CBF and CMR levodopa responses in the same animal. Rats with unilateral 6-OHDA or sham lesion underwent sequential 15O-water (H215O) and 18F-fluorodeoxyglucose (FDG) microPET to map CBF and CMR following the injection of levodopa or saline. A subset of animals was separately scanned under ketamine/xylazine and isoflurane to compare the effects of these anesthetics. Regardless of anesthetic agent, 6-OHDA animals exhibited significant dissociation of vasomotor (ΔCBF) and metabolic (ΔCMR) responses to levodopa, with stereotyped increases in CBF and reductions in CMR in the basal ganglia ipsilateral to the dopamine lesion. No significant changes were seen in sham-lesioned animals. These data faithfully recapitulate analogous dissociation effects observed previously in human PD subjects scanned sequentially during levodopa infusion. This approach may have utility in the assessment of new drugs targeting the exaggerated regional vasomotor responses seen in human PD and in experimental models of levodopa-induced dyskinesia.
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Affiliation(s)
- Renata P Lerner
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Zisis Bimpisidis
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden.
| | - Stergiani Agorastos
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Sandra Scherrer
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Stephen L Dewey
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - M Angela Cenci
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden.
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
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Molmenti EP, Alex A, Rosen L, Alexander M, Nicastro J, Yang J, Siskind E, Alex L, Sameyah E, Bhaskaran M, Ali N, Basu A, Sachdeva M, Agorastos S, Rajendran P, Krishnan P, Ramadas P, Amodu L, Cagliani J, Rehman S, Kressel A, Sethna CB, Sotiropoulos GC, Radtke A, Sgourakis G, Schwarz R, Fishbane S, Bellucci A, Coppa G, Rilo H, Molmenti CL. Recipient Criteria Predictive of Graft Failure in Kidney Transplantation. Int J Angiol 2015; 25:29-38. [PMID: 26900309 DOI: 10.1055/s-0035-1563605] [Citation(s) in RCA: 8] [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] [Indexed: 10/23/2022] Open
Abstract
Several classifications systems have been developed to predict outcomes of kidney transplantation based on donor variables. This study aims to identify kidney transplant recipient variables that would predict graft outcome irrespective of donor characteristics. All U.S. kidney transplant recipients between October 25,1999 and January 1, 2007 were reviewed. Cox proportional hazards regression was used to model time until graft failure. Death-censored and nondeath-censored graft survival models were generated for recipients of live and deceased donor organs. Recipient age, gender, body mass index (BMI), presence of cardiac risk factors, peripheral vascular disease, pulmonary disease, diabetes, cerebrovascular disease, history of malignancy, hepatitis B core antibody, hepatitis C infection, dialysis status, panel-reactive antibodies (PRA), geographic region, educational level, and prior kidney transplant were evaluated in all kidney transplant recipients. Among the 88,284 adult transplant recipients the following groups had increased risk of graft failure: younger and older recipients, increasing PRA (hazard ratio [HR],1.03-1.06], increasing BMI (HR, 1.04-1.62), previous kidney transplant (HR, 1.17-1.26), dialysis at the time of transplantation (HR, 1.39-1.51), hepatitis C infection (HR, 1.41-1.63), and educational level (HR, 1.05-1.42). Predictive criteria based on recipient characteristics could guide organ allocation, risk stratification, and patient expectations in planning kidney transplantation.
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Affiliation(s)
- Ernesto P Molmenti
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York; Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New York
| | - Asha Alex
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Lisa Rosen
- The Feinstein Institute for Medical Research, Hofstra North Shore-LIJ School of Medicine, New York
| | - Mohini Alexander
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New York
| | - Jeffrey Nicastro
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Jingyan Yang
- Mailman School of Public Health, Columbia University, New York
| | - Eric Siskind
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Leesha Alex
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Emil Sameyah
- The Feinstein Institute for Medical Research, Hofstra North Shore-LIJ School of Medicine, New York
| | - Madhu Bhaskaran
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New York
| | - Nicole Ali
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New York
| | - Amit Basu
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Mala Sachdeva
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New York
| | | | - Prejith Rajendran
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Prathik Krishnan
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Poornima Ramadas
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Leo Amodu
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Joaquin Cagliani
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Sameer Rehman
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Adam Kressel
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Christine B Sethna
- Department of Pediatrics, Hofstra North Shore-LIJ School of Medicine, New York
| | - Georgios C Sotiropoulos
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Arnold Radtke
- Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus, Muenster, Germany
| | - George Sgourakis
- Department of General Surgery, Red Cross Hospital, Athens, Greece
| | - Richard Schwarz
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New York
| | - Steven Fishbane
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New York
| | - Alessandro Bellucci
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New York
| | - Gene Coppa
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
| | - Horacio Rilo
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, New York
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Siskind E, Alex A, Alexander M, Akerman M, Mathew C, Fishbane L, Thomas J, Israel E, Fana M, Evans C, Godwin A, Agorastos S, Mellace B, Rosado J, Rajendran PP, Krishnan P, Ramadas P, Flecha A, Kiernan L, Morgan RM, Ali N, Sachdeva M, Calderon K, Hong S, Kaur J, Basu A, Nicastro J, Coppa G, Bhaskaran M, Molmenti E. Factors associated with completion of pre-kidney transplant evaluations. Int J Angiol 2014; 23:23-8. [PMID: 24627614 DOI: 10.1055/s-0033-1358661] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This study sought to examine various factors that may prevent transplant candidates from completing their transplant workup prior to listing. We reviewed the records of 170 subjects (cases = 100, controls 70) who were either on dialysis or had less than 20 mL/min creatinine clearance and were therefore candidates for preemptive transplantation. Approximately, 56% of preemptive patients completed their workup, while only 36% of patients on dialysis completed their workup. Our data revealed that factors contributing toward completion of workup included intrinsic motivation (four times more likely), lack of specific medical comorbidities (three times more likely), and preemptive status (two times more likely). Among patients on dialysis, intrinsic motivation (five times more likely) and absence of cardiovascular complications (four times more likely) were associated with completion. When comparing patients on dialysis to patients not on dialysis, there were significant differences between the two groups in distance from home to the transplant center, level of education, and presence of medical comorbidities. We believe that targeted interventions such as timely referral, providing appropriate educational resources, and development of adequate support systems, have the potential to improve workup compliance of patients with advanced chronic kidney disease, including those on dialysis.
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Affiliation(s)
- Eric Siskind
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Asha Alex
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Mohini Alexander
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Meredith Akerman
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Christine Mathew
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Lara Fishbane
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Jisha Thomas
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Ezra Israel
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Melissa Fana
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Cory Evans
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Andrew Godwin
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Stergiani Agorastos
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Barbara Mellace
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Jesus Rosado
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Prejith P Rajendran
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Prathik Krishnan
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Poornima Ramadas
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Antonette Flecha
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Lisa Kiernan
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Ruth M Morgan
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Nicole Ali
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Mala Sachdeva
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Kellie Calderon
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Susana Hong
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Jasmeet Kaur
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Amit Basu
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Jeffrey Nicastro
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Gene Coppa
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Madhu Bhaskaran
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Ernesto Molmenti
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
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Agorastos S, Alex A, Feldman J, Kuncewitch M, Deutsch G, Siskind E, Nicastro J, Coppa GF, Conte C, Beg M, Kadison A, Ricci J, Wang JHY, Zaidi R, O'Connor L, Nimaroff M, Molmenti EP, Sullivan JD. Robotic resection of retrorectal tumor: an alternative to the Kraske procedure. ACTA ACUST UNITED AC 2013. [DOI: 10.5430/jst.v3n4p13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Aguirre WE, Shervette VR, Navarrete R, Calle P, Agorastos S. Morphological and Genetic Divergence of Hoplias microlepis (Characiformes: Erythrinidae) in Rivers and Artificial Impoundments of Western Ecuador. COPEIA 2013. [DOI: 10.1643/ci-12-083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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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Siskind E, Villa M, Jaimes N, Huntoon K, Alex A, Blum M, Tyrell R, Sameyah E, Kuncewitch M, Giangola M, Agorastos S, Deutsch G, Plumley L, Shen A, Robinson M, Alexander M, Israel E, Lumermann L, Bhaskaran M, Calderon K, Jhaveri KD, Sachdeva M, Bellucci A, Mattana J, Fishbane S, D'Agostino C, Nicastro J, Coppa G, Molmenti E. Forty-eight hour kidney transplant admissions. Clin Transplant 2013; 27:E431-4. [PMID: 23803179 DOI: 10.1111/ctr.12178] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 11/30/2022]
Abstract
Forty-eight hour kidney transplantation admissions are a feasible option in selected recipients of live-donor allografts through the use of standardized post-operative protocols, multidisciplinary team patient care, and intensive follow-up at outpatient centers. Age, gender, and pre-transplant dialysis status did not impact the ability to achieve 48-hour admissions. We did not identify any other pre-operative risk factors that contributed to increased length of stay. Although ABO and highly sensitized recipients had longer lengths of stay, the subgroup was too small to achieve statistical significance. We did not encounter any readmissions within the first seven post-operative days. Further improvements in clinical management will enhance the potential to shorten the length of hospital stay for all kidney transplant recipients.
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Affiliation(s)
- Eric Siskind
- Department of Transplantation, North Shore Long Island Jewish Health System, Manhasset, NY, USA.
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