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Yadlosky LB, Mowrey WB, Pimentel SS. Risky business: Considerations of emotion regulation and high-risk behaviors in anxious adolescents. J Anxiety Disord 2023; 99:102760. [PMID: 37672917 DOI: 10.1016/j.janxdis.2023.102760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
A growing body of empirical literature connects anxiety symptoms and high-risk suicidal and self-harming behaviors in youth. Emotion regulation (ER) processes and deficits have been identified as important factors in the etiology, maintenance, and treatment of both youth anxiety and high-risk behaviors. The present study assessed the association between these variables using an acute, socio-demographically diverse clinical sample of youth presenting to an outpatient mental health clinic. Ninety-nine youth aged 12-20 years old completed measures of anxiety symptoms, ER difficulties, and lifetime history of high-risk behaviors including non-suicidal self-injury (NSSI) and suicide attempts. Unadjusted analyses show that more severe anxiety symptoms were associated with more ER difficulties and history of risk behavior. Multivariate linear regression models considering age, sex, race/ethnicity, and risk history show that more severe anxiety symptoms remained significantly associated with more ER difficulties (p < 0.0001) and positive suicide attempt history (p < 0.01). Findings highlight the importance of integrating considerations of ER into the case conceptualization and treatment planning of high-risk, anxious youth to inform evidenced-based care with this population. The need for targeted, ongoing risk assessment with anxious youth to identify and mitigate risk is also demonstrated.
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Affiliation(s)
- Lauren B Yadlosky
- Montefiore Medical Center | Albert Einstein College of Medicine, USA.
| | - Wenzhu B Mowrey
- Montefiore Medical Center | Albert Einstein College of Medicine, USA
| | - Sandra S Pimentel
- Montefiore Medical Center | Albert Einstein College of Medicine, USA
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2
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Saletti PG, Mowrey WB, Liu W, Li Q, McCullough J, Aniceto R, Lin I, Eklund M, Casillas‐Espinosa PM, Ali I, Santana‐Gomez C, Coles L, Shultz SR, Jones N, Staba R, O'Brien TJ, Moshé SL, Agoston DV, Galanopoulou AS. Early preclinical plasma protein biomarkers of brain trauma are influenced by early seizures and levetiracetam. Epilepsia Open 2023; 8:586-608. [PMID: 37026764 PMCID: PMC10235584 DOI: 10.1002/epi4.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE We used the lateral fluid percussion injury (LFPI) model of moderate-to-severe traumatic brain injury (TBI) to identify early plasma biomarkers predicting injury, early post-traumatic seizures or neuromotor functional recovery (neuroscores), considering the effect of levetiracetam, which is commonly given after severe TBI. METHODS Adult male Sprague-Dawley rats underwent left parietal LFPI, received levetiracetam (200 mg/kg bolus, 200 mg/kg/day subcutaneously for 7 days [7d]) or vehicle post-LFPI, and were continuously video-EEG recorded (n = 14/group). Sham (craniotomy only, n = 6), and naïve controls (n = 10) were also used. Neuroscores and plasma collection were done at 2d or 7d post-LFPI or equivalent timepoints in sham/naïve. Plasma protein biomarker levels were determined by reverse phase protein microarray and classified according to injury severity (LFPI vs. sham/control), levetiracetam treatment, early seizures, and 2d-to-7d neuroscore recovery, using machine learning. RESULTS Low 2d plasma levels of Thr231 -phosphorylated tau protein (pTAU-Thr231 ) and S100B combined (ROC AUC = 0.7790) predicted prior craniotomy surgery (diagnostic biomarker). Levetiracetam-treated LFPI rats were differentiated from vehicle treated by the 2d-HMGB1, 2d-pTAU-Thr231 , and 2d-UCHL1 plasma levels combined (ROC AUC = 0.9394) (pharmacodynamic biomarker). Levetiracetam prevented the seizure effects on two biomarkers that predicted early seizures only among vehicle-treated LFPI rats: pTAU-Thr231 (ROC AUC = 1) and UCHL1 (ROC AUC = 0.8333) (prognostic biomarker of early seizures among vehicle-treated LFPI rats). Levetiracetam-resistant early seizures were predicted by high 2d-IFNγ plasma levels (ROC AUC = 0.8750) (response biomarker). 2d-to-7d neuroscore recovery was best predicted by higher 2d-S100B, lower 2d-HMGB1, and 2d-to-7d increase in HMGB1 or decrease in TNF (P < 0.05) (prognostic biomarkers). SIGNIFICANCE Antiseizure medications and early seizures need to be considered in the interpretation of early post-traumatic biomarkers.
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Affiliation(s)
- Patricia G. Saletti
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Wenzhu B. Mowrey
- Department of Epidemiology & Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Wei Liu
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Qianyun Li
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Jesse McCullough
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Roxanne Aniceto
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - I‐Hsuan Lin
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Michael Eklund
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Pablo M. Casillas‐Espinosa
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Idrish Ali
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | | | - Lisa Coles
- University of Minnesota Twin CitiesMinneapolisMinnesotaUSA
| | - Sandy R. Shultz
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Nigel Jones
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | | | - Terence J. O'Brien
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Solomon L. Moshé
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
- Isabelle Rapin Division of Child NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Dominick P Purpura Department of NeuroscienceAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of PediatricsAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Denes V. Agoston
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Aristea S. Galanopoulou
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
- Isabelle Rapin Division of Child NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Dominick P Purpura Department of NeuroscienceAlbert Einstein College of MedicineBronxNew YorkUSA
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Duong MD, Wang S, Schwartz D, Mowrey WB, Broder A, Goilav B. Total cortical interstitial inflammation predicts chronic kidney disease progression in patients with lupus nephritis. Nephrol Dial Transplant 2023; 38:1469-1476. [PMID: 36220148 PMCID: PMC10229284 DOI: 10.1093/ndt/gfac286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND End-stage kidney disease (ESKD) from lupus nephritis (LN) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Kidney biopsy is the gold standard for diagnosis and prognostication of LN. While interstitial fibrosis and tubular atrophy (IFTA) predict progression to ESKD, the National Institutes of Health (NIH) classification of interstitial inflammation in unscarred cortical parenchyma is not predictive of chronic kidney disease (CKD) progression. The objective of this study was to determine whether total cortical interstitial inflammation that accounts for inflammation in the entire cortical parenchyma could predict CKD progression in patients with LN. Early identification of at-risk patients may improve outcomes. METHODS This retrospective cohort study included 125 SLE patients with LN class III, IV, V or mixed (III/V, IV/V) on the index biopsy (2005-2018). Kidney biopsies were reviewed and assigned based on the 2018 NIH Activity Index (AI) and tubulointerstitial lesion categories. Total interstitial inflammation in the entire cortical parenchyma was graded as 0, 1, 2 or 3, corresponding to <10%, 10-25%, 26-50% and >50%, respectively, of the total cortical parenchyma containing an inflammatory infiltrate (similar to the definition used in the Banff total inflammation score). CKD progression was defined as an estimated glomerular filtration rate decrease of ≥30% within 5 years after the index biopsy. Kaplan-Meier survival curves and Cox proportional hazards models were performed to compare the two scoring systems, the total cortical intestinal inflammation score and the NIH interstitial inflammation score as predictors of CKD progression. RESULTS Of 125 patients, 46 experienced CKD progression; 21 of 46 subsequently developed ESKD, 28 (22.4%) had moderate-severe total cortical interstitial inflammation and 8 (6.4%) had moderate-severe NIH interstitial inflammation. There were no differences in baseline characteristics between progressors and nonprogressors. Total cortical interstitial inflammation was associated with CKD progression in time-dependent analyses [hazard ratio 2.45 (95% confidence interval 1.2-4.97)] adjusted for age at biopsy, race, sex, LN class and hypertensive vascular change on kidney biopsy. The NIH interstitial inflammation was not associated with CKD progression. CONCLUSIONS In contrast to the current NIH interstitial inflammation classification, accounting for interstitial inflammation in the entire cortical parenchyma allows identification of patients at risk for CKD progression in LN.
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Affiliation(s)
- Minh Dien Duong
- Department of Pediatrics, Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shudan Wang
- Department of Medicine, Rheumatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Schwartz
- Department of Surgical Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wenzhu B Mowrey
- Department of Epidemiology and Biostatistics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anna Broder
- Department of Medicine, Rheumatology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Beatrice Goilav
- Department of Pediatrics, Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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Broder A, Mowrey WB, Valle A, Kim M, Feldman CH, Yoshida K, Costenbader KH. Prescribing Patterns of Hydroxychloroquine and Glucocorticoids Among Lupus Patients After New-Onset End-Stage Renal Disease. Arthritis Care Res (Hoboken) 2022; 74:2024-2032. [PMID: 34121346 PMCID: PMC9205678 DOI: 10.1002/acr.24728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 12/04/2020] [Revised: 04/16/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Optimal strategies for managing lupus medications after end-stage renal disease (ESRD) have not been addressed. The objective was to identify the current US-wide prescribing patterns of hydroxychloroquine (HCQ) and oral glucocorticoids (GS) among systemic lupus erythematosus (SLE) patients with incident ESRD enrolled in the US Renal Data System (USRDS) registry. METHODS We identified incident ESRD patients age ≥18 years with SLE as a primary cause of ESRD between January 2006 and June 2013. Patients who were started on dialysis at ESRD onset and enrolled in Medicare Part D within 93 days as required by Medicare were included. RESULTS Among the 2,654 new-onset ESRD patients with Part D, the median duration of follow-up was 761 days (interquartile range [IQR] 374-1,375). At baseline, 1,076 patients (41%) were not receiving HCQ or GS, 220 (8%) were prescribed HCQ alone, 509 (19%) were prescribed both HCQ and GS, and 849 (32%) were prescribed GS alone. Of the 1,983 patients who either never received or discontinued HCQ after ESRD onset, 667 (34%) continued GS to the end of the follow-up period. The median GS dose was lower for patients taking HCQ (14 mg [IQR 9-21]) compared to patients who were never prescribed HCQ (15 mg [IQR 9-27]) or patients who discontinued HCQ after ESRD (17 mg [IQR 10-27]; P = 0.001). CONCLUSION Approximately one-third of patients with lupus nephritis and new-onset ESRD received GS monotherapy at high doses. As GS-related complications contribute to hospitalizations and deaths in SLE ESRD, changing these prescribing practices may improve morbidity and mortality outcomes.
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Affiliation(s)
- Anna Broder
- Hackensack Meridian School of Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | | | - Ana Valle
- Montefiore Medical Center, Bronx, New York
| | - Mimi Kim
- Albert Einstein College of Medicine, Bronx, New York
| | - Candace H Feldman
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Kazuki Yoshida
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Karen H Costenbader
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
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5
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Jimenez AL, Valle A, Mustehsan MH, Wang S, Law J, Guerrero MS, Mowrey WB, Horton DB, Briceno D, Broder A. Association of Hydroxychloroquine Dose With Adverse Cardiac Events in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2022. [PMID: 36331104 PMCID: PMC10156898 DOI: 10.1002/acr.25052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether hydroxychloroquine (HCQ) dose is associated with adverse cardiac outcomes in patients with systemic lupus erythematosus (SLE). METHODS Patients with SLE taking HCQ and with ≥1 echocardiogram followed at a tertiary care center in the Bronx, New York between 2005 and 2021 were included. The HCQ weight-based dose at the HCQ start date was the main exposure of interest. The outcome was incident all-cause heart failure with reduced ejection fraction (HFrEF), life-threatening arrhythmia, or cardiac death. We used Fine-Gray regression models with death as a competing event to study the association of HCQ dose with the outcome. Due to a significant interaction between smoking and HCQ exposure, models were stratified by smoking status. Propensity score analysis was performed as a secondary analysis. RESULTS Of 294 patients, 37 (13%) developed the outcome over a median follow-up time of 7.9 years (interquartile range [IQR] 4.2-12.3 years). In nonsmokers (n = 226), multivariable analysis adjusted for age, body mass index, hypertension, chronic kidney disease, diabetes mellitus, and thromboembolism showed that higher HCQ weight-based doses were not associated with an increased risk of the outcome (subdistribution hazard ratio [HR] 0.62 [IQR 0.41-0.92], P = 0.02). Similarly, higher baseline HCQ doses were not associated with a higher risk of the outcome among smokers (n = 68) (subdistribution HR 0.85 [IQR 0.53-1.34] per mg/kg, P = 0.48). Propensity score analysis showed comparable results. CONCLUSION Higher HCQ doses were not associated with an increased risk of HFrEF, life-threatening arrhythmia, or cardiac death among patients with SLE and may decrease the risk among nonsmokers.
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Affiliation(s)
| | - Ana Valle
- Albert Einstein College of Medicine/Montefiore Medical Center, the Bronx, New York
| | | | - Shudan Wang
- Albert Einstein College of Medicine/Montefiore Medical Center, the Bronx, New York
| | - Jammie Law
- Albert Einstein College of Medicine/Montefiore Medical Center, the Bronx, New York
| | | | - Wenzhu B Mowrey
- Albert Einstein College of Medicine/Montefiore Medical Center, the Bronx, New York
| | - Daniel B Horton
- Rutgers Center for Pharmacoepidemiology and Treatment Science and Institute for Health, Health Care Policy, and Aging Research, New Brunswick, New Jersey
| | | | - Anna Broder
- Hackensack University Hospital, Hackensack, New Jersey
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6
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Cui MH, Billett HH, Suzuka SM, Ambadipudi K, Archarya S, Mowrey WB, Branch CA. Corrected cerebral blood flow and reduced cerebral inflammation in berk sickle mice with higher fetal hemoglobin. Transl Res 2022; 244:75-87. [PMID: 35091127 DOI: 10.1016/j.trsl.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
Abstract
Fetal hemoglobin (HbF) is known to lessen the severity of sickle cell disease (SCD), through reductions in peripheral vaso-occlusive disease and reduced risk for cerebrovascular events. However, the influence of HbF on oxygen delivery to high metabolism tissues like the brain, or its influence on cerebral perfusion, metabolism, inflammation or function have not been widely studied. We employed a Berkley mouse model (BERK) of SCD with gamma transgenes q3 expressing exclusively human α- and βS-globins with varying levels of γ globin expression to investigate the effect of HbF expression on the brain using magnetic resonance imaging (MRI), MRI diffusion tensor imaging (DTI) and spectroscopy (MRS) and hematological parameters. Hematological parameters improved with increasing γ level expression, as did markers for brain metabolism, perfusion and inflammation. Brain microstructure assessed by DTI fractional anisotropy improved, while myo-inositol levels increased, suggesting improved microstructural integrity and reduced cell loss. Our results suggest that increasing γ levels not only improves sickle peripheral disease, but also improves brain perfusion and oxygen delivery while reducing brain inflammation while protecting brain microstructural integrity.
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Affiliation(s)
- Min-Hui Cui
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York; Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Henny H Billett
- Department of Medicine, Albert Einstein College of Medicine, New York, New York; Department of Pathology, Albert Einstein College of Medicine, New York, New York
| | - Sandra M Suzuka
- Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Kamalakar Ambadipudi
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York
| | - Seetharama Archarya
- Department of Medicine, Albert Einstein College of Medicine, New York, New York; Department of Physiology & Biophysics, Albert Einstein College of Medicine, New York, New York
| | - Wenzhu B Mowrey
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, New York
| | - Craig A Branch
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York; Department of Physiology & Biophysics, Albert Einstein College of Medicine, New York, New York.
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7
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Naidu I, Ryvlin J, Videlefsky D, Qin J, Mowrey WB, Choi JH, Citron C, Gary J, Benton JA, Weiss BT, Longo M, Matmati NN, De la Garza Ramos R, Krystal J, Echt M, Gelfand Y, Cezayirli P, Yassari N, Wang B, Castro-Rivas E, Headlam M, Udemba A, Williams L, Gitkind AI, Yassari R, Yanamadala V. The Effect of a Multidisciplinary Spine Clinic on Time to Care in Patients with Chronic Back and/or Leg Pain: A Propensity Score-Matched Analysis. J Clin Med 2022; 11:2583. [PMID: 35566709 PMCID: PMC9103560 DOI: 10.3390/jcm11092583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study was to compare the care in a unidisciplinary (USC) versus multidisciplinary (MSC) spine clinic, where patients are evaluated by different specialists during the same office visit. Adult patients presenting with a chief complaint of back and/or leg pain between June 2018 and July 2019 were assessed for eligibility. The main outcome measures included the first treatment recommendations, the time to treatment order, and the time to treatment occurrence. A 1:1 propensity score-matched analysis was performed on 874 patients (437 in each group). For all patients, the most common recommendation was physical therapy (41.4%), followed by injection (14.6%), and surgery (9.7%). Patients seen in the MSC were more likely to be recommended injection (p < 0.001) and less likely to be recommended surgery as first treatment (p = 0.001). They also had significantly shorter times to the injection order (log-rank test, p = 0.004) and the injection occurrence (log-rank test, p < 0.001). In this study, more efficient care for patients with back and/or leg pain was delivered in the MSC setting, which was evidenced by the shorter times to the injection order and occurrence. The impact of the MSC approach on patient satisfaction and health-related quality-of-life outcome measures warrants further investigation.
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Affiliation(s)
- Ishan Naidu
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Jessica Ryvlin
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Devin Videlefsky
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Jiyue Qin
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY 10461, USA; (J.Q.); (W.B.M.)
| | - Wenzhu B. Mowrey
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY 10461, USA; (J.Q.); (W.B.M.)
| | - Jong H. Choi
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Chloe Citron
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - James Gary
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Joshua A. Benton
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Brandon T. Weiss
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Michael Longo
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Nabil N. Matmati
- School of Medicine, Quinnipiac University, North Haven, CT 06518, USA;
| | - Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Jonathan Krystal
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA;
| | - Murray Echt
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Yaroslav Gelfand
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Phillip Cezayirli
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Neeky Yassari
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Benjamin Wang
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Erida Castro-Rivas
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Mark Headlam
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Adaobi Udemba
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Lavinia Williams
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Andrew I. Gitkind
- Department of Rehabilitation Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA;
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Vijay Yanamadala
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
- Hartford HealthCare, Westport, CT 06880, USA
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Becker SD, Rochelson E, Lienhard M, Silber D, Mowrey WB, Hutchison L. Screening Electrocardiograms Have Low Utility in Medical Clearance Before Pediatric Inpatient Psychiatric Admission. Pediatr Emerg Care 2022; 38:e393-e397. [PMID: 34986593 DOI: 10.1097/pec.0000000000002298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children presenting to the emergency department (ED) requiring psychiatric admission often undergo screening electrocardiograms (ECG) as part of the medical clearance process. The diagnostic yield of screening ECGs for this purpose has not been reported. The purpose of this study was to determine the clinical utility of screening ECGs in children and adolescents requiring acute inpatient psychiatric admission. METHODS A single-center retrospective study of patients aged 5 to 18 years who did not have documented indications for ECG and underwent screening ECG before psychiatric inpatient admission over a 2-year period was conducted. Abnormal ECGs were identified via chart review and were reinterpreted by a pediatric cardiologist to determine potential significance to psychiatric care. Impact on treatment and disposition was examined. RESULTS From January 2018 through December 2019, 252 eligible pediatric patients had a screening ECG in the ED before psychiatric admission. Twenty-one (8.3%) of these ECGs were interpreted as abnormal, and 6 (2.4%) were determined to be potentially relevant to psychiatric care in the setting of specific medication use. The abnormal ECG interpretations resulted in additional workup and/or cardiology consultation for 7 (2.7%) patients but had no impact on psychiatric admission. CONCLUSIONS In the absence of concerning individual or family history or cardiac symptoms, routine screening ECGs as part of medical clearance for psychiatric admission are not warranted given the low yield of meaningful findings. The decision to obtain an ECG should be made with careful consideration of medical history and in the presence of specific indications.
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Affiliation(s)
- Sarah D Becker
- From the Division of Child and Adolescent Psychiatry, Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell at Zucker Hillside Hospital, Glen Oaks, NY
| | - Ellis Rochelson
- Division of pediatric cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Michael Lienhard
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - David Silber
- Medical Student, Albert Einstein College of Medicine, Bronx, NY Medical Student, Albert Einstein College of Medicine, Bronx, NY
| | - Wenzhu B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Lisa Hutchison
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
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Benton JA, Weiss BT, Mowrey WB, Yassari N, Wang B, Ramos RDLG, Gelfand Y, Castro-Rivas E, Puthenpura V, Yassari R, Yanamadala V. Association of Medicare and Medicaid Insurance Status with Increased Spine Surgery Utilization Rates. Spine (Phila Pa 1976) 2021; 46:E939-E944. [PMID: 33496542 DOI: 10.1097/brs.0000000000003968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective single-institution study. OBJECTIVE The aim of this study was to determine the relationship between patients' insurance status and the likelihood for them to be recommended various spine interventions upon evaluation in our neurosurgical clinics. SUMMARY OF BACKGROUND DATA Socioeconomically disadvantaged populations have worse outcomes after spine surgery. No studies have looked at the differential rates of recommendation for surgery for patients presenting to spine surgeons based on socioeconomic status. METHODS We studied patients initially seeking spine care from spine-fellowship trained neurosurgeons at our institution from July 1, 2018 to June 30, 2019. Multivariable logistic regression was used to assess the association between insurance status and the recommended patient treatment. RESULTS Overall, 663 consecutive outpatients met inclusion criteria. Univariate analysis revealed a statistically significant association between insurance status and treatment recommendations for surgery (P < 0.001). Multivariate logistic regression demonstrated that compared with private insurance, Medicare (odds ratio [OR] 3.54, 95% confidence interval [CI] 1.21-7.53, P = 0.001) and Medicaid patients (OR 2.46, 95% CI 1.21-5.17, P = 0.014) were more likely to be recommended for surgery. Uninsured patients did not receive recommendations for surgery at significantly different rates than patients with private insurance. CONCLUSION Medicare and Medicaid patients are more likely to be recommended for spine surgery when initially seeking spine care from a neurosurgeon. These findings may stem from a number of factors, including differential severity of the patient's condition at presentation, disparities in access to care, and differences in shared decision making between surgeons and patients.Level of Evidence: 3.
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Affiliation(s)
- Joshua A Benton
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Brandon T Weiss
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Wenzhu B Mowrey
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY
| | - Neeky Yassari
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Benjamin Wang
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Rafael De La Garza Ramos
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Yaroslav Gelfand
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Erida Castro-Rivas
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Vidya Puthenpura
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Yale School of Medicine and Yale-New Haven Hospital, New Haven, CT
| | - Reza Yassari
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Vijay Yanamadala
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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Akman O, Briggs SW, Mowrey WB, Moshé SL, Galanopoulou AS. Antiepileptogenic effects of rapamycin in a model of infantile spasms due to structural lesions. Epilepsia 2021; 62:1985-1999. [PMID: 34212374 DOI: 10.1111/epi.16975] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/01/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Infantile spasms may evolve into persistent epilepsies including Lennox-Gastaut syndrome. We compared adult epilepsy outcomes in models of infantile spasms due to structural etiology (multiple-hit model) or focal cortical inflammation and determined the anti-epileptogenic effects of pulse-rapamycin, previously shown to stop spasms in multiple-hit rats. METHODS Spasms were induced in 3-day-old male rats via right intracerebral doxorubicin/lipopolysaccharide (multiple-hit model) infusions. Controls and sham rats were used. Separate multiple-hit rats received pulse-rapamycin or vehicle intraperitoneally between postnatal days 4 and 6. In adult mice, video-EEG (electroencephalography) scoring for seizures and sleep and histology were done blinded to treatment. RESULTS Motor-type seizures developed in 66.7% of multiple-hit rats, usually from sleep, but were reduced in the pulse-rapamycin-treated group (20%, p = .043 vs multiple-hit) and rare in other groups (0-9.1%, p < .05 vs multiple-hit). Spike-and-wave bursts had a slower frequency in multiple-hit rats (5.4-5.8Hz) than in the other groups (7.6-8.3Hz) (p < .05); pulse rapamycin had no effect on the hourly spike-and-wave burst rates in adulthood. Rapamycin, however, reduced the time spent in slow-wave-sleep (17.2%), which was increased in multiple-hit rats (71.6%, p = .003). Sham rats spent more time in wakefulness (43.7%) compared to controls (30.6%, p = .043). Multiple-hit rats, with or without rapamycin treatment, had right more than left corticohippocampal, basal ganglia lesions. There was no macroscopic pathology in the other groups. SIGNIFICANCE Structural corticohippocampal/basal ganglia lesions increase the risk for post-infantile spasms epilepsy, Lennox-Gastaut syndrome features, and sleep dysregulation. Pulse rapamycin treatment for infantile spasms has anti-epileptogenic effects, despite the structural lesions, and decreases the time spent in slow wave sleep.
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Affiliation(s)
- Ozlem Akman
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Bronx, New York, USA
| | - Stephen W Briggs
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Bronx, New York, USA
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Bronx, New York, USA
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Bronx, New York, USA.,Isabelle Rapin Division of Child Neurology, Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Center, Bronx, New York, USA.,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aristea S Galanopoulou
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Bronx, New York, USA.,Isabelle Rapin Division of Child Neurology, Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Center, Bronx, New York, USA
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11
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Benton JA, Mowrey WB, Ramos RDLG, Weiss BT, Gelfand Y, Castro-Rivas E, Williams L, Headlam M, Udemba A, Gitkind AI, Krystal JD, Cho W, Kinon MD, Yassari R, Yanamadala V. A Multidisciplinary Spine Surgical Indications Conference Leads to Alterations in Surgical Plans in a Significant Number of Cases: A Case Series. Spine (Phila Pa 1976) 2021; 46:E48-E55. [PMID: 32991516 DOI: 10.1097/brs.0000000000003715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case series. OBJECTIVE To evaluate the impact of a multidisciplinary spine surgery indications conference (MSSIC) on surgical planning for elective spine surgeries. SUMMARY OF BACKGROUND DATA Identifying methods for pairing the proper patient with the optimal intervention is of the utmost importance for improving spine care and patient outcomes. Prior studies have evaluated the utility of multidisciplinary spine conferences for patient management, but none have evaluated the impact of a MSSIC on surgical planning and decision making. METHODS We implemented a mandatory weekly MSSIC with all spine surgeons at our institution. Each elective spine surgery in the upcoming week is presented. Subsequently, a group consensus decision is achieved regarding the best treatment option based on the expertise and opinions of the participating surgeons. We reviewed cases presented at the MSSIC from September 2019 to December 2019. We compared the surgeon's initial proposed surgery for a patient with the conference attendees' consensus decision on the best treatment and measured compliance rates with the group's recommended treatment. RESULTS The conference reviewed 100 patients scheduled for elective spine surgery at our indications conference during the study period. Surgical plans were recommended for alteration in 19 cases (19%) with the proportion statistically significant from zero indicated by a binomial test (P < 0.001). The median absolute change in the invasiveness index of the altered procedures was 3 (interquartile range [IQR] 1-4). Participating surgeons complied with the group's recommendation in 96.5% of cases. CONCLUSION In conjunction with other multidisciplinary methods, MSSICs can lead to surgical planning alterations in a significant number of cases. This could potentially result in better selection of surgical candidates and procedures for particular patients. Although long-term patient outcomes remain to be evaluated, this care model will likely play an integral role in optimizing the care spine surgeons provide patients. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Joshua A Benton
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Wenzhu B Mowrey
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Rafael De La Garza Ramos
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Brandon T Weiss
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Yaroslav Gelfand
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Erida Castro-Rivas
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Lavinia Williams
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Mark Headlam
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Adaobi Udemba
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Andrew I Gitkind
- Department of Rehabilitation Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Jonathan D Krystal
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Woojin Cho
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Merritt D Kinon
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Reza Yassari
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Vijay Yanamadala
- Center for Surgical Optimization, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Spinal Disorders Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
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Rubinstein TB, Bullock DR, Ardalan K, Mowrey WB, Brown NM, Bauman LJ, Stein REK. Adverse Childhood Experiences Are Associated with Childhood-Onset Arthritis in a National Sample of US Youth: An Analysis of the 2016 National Survey of Children's Health. J Pediatr 2020; 226:243-250.e2. [PMID: 32553837 DOI: 10.1016/j.jpeds.2020.06.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 02/26/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine whether there is an association between adverse childhood experiences (ACEs) and childhood-onset arthritis, comparing youth with arthritis to both healthy youth and youth with other acquired chronic physical diseases (OCPD); and to examine whether ACEs are associated with disease-related characteristics among children with arthritis. STUDY DESIGN In a cross-sectional analysis of data from the 2016 National Survey of Children's Health we examined whether ACEs were associated with having arthritis vs either being healthy or having a nonrheumatologic OCPD. ACE scores were categorized as 0, 1, 2-3, ≥4 ACEs. Multinomial logistic regression models examined associations between ACEs and health status while adjusting for age, sex, race/ethnicity, and poverty status. Among children with arthritis, associations between ACEs and disease-related characteristics were assessed by Pearson χ2 analyses. RESULTS Compared with children with no ACEs, children with 1, 2-3, and ≥4 ACEs had an increased odds of having arthritis vs being healthy (adjusted OR for ≥4 ACEs, 9.4; 95% CI, 4.0-22.1) and vs OCPD (adjusted OR for ≥4 ACEs, 3.7; 95% CI-1.7, 8.1). Among children with arthritis, ACEs were associated with worse physical impairment. CONCLUSIONS Children with higher numbers of ACEs are more likely to have arthritis, when arthritis status is compared either with being healthy or with having OCPD. Further studies are needed to determine the direction of the association between ACEs and childhood arthritis, its impact on disease course, and potential intervention targets that might mitigate these effects.
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Affiliation(s)
- Tamar B Rubinstein
- Division of Pediatric Rheumatology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Division of Pediatric Rheumatology, Children's Hospital at Montefiore, Bronx, NY.
| | - Danielle R Bullock
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Kaveh Ardalan
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC; Division of Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Wenzhu B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Nicole M Brown
- Albert Einstein College of Medicine, Bronx, NY; Strong Children Wellness Medical Group Jamaica, NY
| | - Laurie J Bauman
- Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
| | - Ruth E K Stein
- Division of Developmental Medicine, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Division of Developmental Medicine, Children's Hospital at Montefiore, Bronx, NY
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Hsia BC, Singh AK, Njeze O, Cosar E, Mowrey WB, Feldman J, Reznik M, Jariwala SP. Developing and evaluating ASTHMAXcel adventures: A novel gamified mobile application for pediatric patients with asthma. Ann Allergy Asthma Immunol 2020; 125:581-588. [PMID: 32711031 PMCID: PMC7375272 DOI: 10.1016/j.anai.2020.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/16/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ASTHMAXcel mobile application has been linked to favorable outcomes among adult patients with asthma. OBJECTIVE To assess the impact of ASTHMAXcel Adventures, a gamified, guideline-based, pediatric version on asthma control, knowledge, health care utilization, and patient satisfaction. METHODS Pediatric patients with asthma received the ASTHMAXcel Adventures mobile intervention on-site only at baseline (visit 1), 4 months (visit 2), and 6 months (visit 3). The asthma control test, asthma illness representation scale-self-administered, pediatric asthma impact survey, and Client Satisfaction Questionnaire-8 were used to assess asthma control, knowledge, and patient satisfaction. Patients reported the number of asthma-related emergency department (ED) visits, hospitalizations, and oral prednisone use. RESULTS A total of 39 patients completed the study. The proportion of controlled asthma increased from visit 1 to visits 2 and 3 (30.8% vs 53.9%, P = .04; 30.8% vs 59.0%, P = .02), and largely seen in boys. The mean asthma illness representation scale-self-administered scores increased from baseline pre- to postintervention, with sustained improvements at visits 2 and 3 (3.55 vs 3.76, P < .001; 3.55 vs 3.80, P = .001; 3.55 vs 3.99, P < .001). The pediatric asthma impact survey scores improved from baseline to visits 2 and 3 (43.33 vs 34.08, P < .001; 43.33 vs 31.74, P < .001). ED visits and prednisone use significantly decreased from baseline to visits 2 and 3 (ED: 0.46 vs 0.13, P = .03; 0.46 vs 0.02, P = .02; prednisone use, 0.49 vs 0.13, P = .02; 0.49 vs 0.03, P = .003. Satisfaction was high with mean client satisfaction questionnaire score of approximately 30 (out of 32) at all visits. CONCLUSION ASTHMAXcel Adventures improved asthma control, knowledge, and quality of life, and reduced ED visits and prednisone use with high satisfaction scores.
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Affiliation(s)
- Brian C Hsia
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Anjani K Singh
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Obumneme Njeze
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Emine Cosar
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan Feldman
- Division of Academic General Pediatrics, Department of Pediatrics, the Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Marina Reznik
- Division of Academic General Pediatrics, Department of Pediatrics, the Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Sunit P Jariwala
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
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Salgado Guerrero M, Londono Jimenez A, Dobrowolski C, Mowrey WB, Goilav B, Wang S, Broder A. Systemic lupus Erythematosus activity and Hydroxychloroquine use before and after end-stage renal disease. BMC Nephrol 2020; 21:450. [PMID: 33115441 PMCID: PMC7592532 DOI: 10.1186/s12882-020-02083-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND SLE manifestations after ESRD may be underdiagnosed and undertreated, contributing to increased morbidity and mortality. Whether specific symptoms persist after ESRD or a shift towards new manifestations occurs has not been extensively studied, especially in the non-Caucasian patients in the United States. In addition, hydroxychloroquine (HCQ) prescribing patterns post-ESRD have not been described. The objective of this study was to assess lupus activity and HCQ prescribing before and after ESRD development. Knowledge gained from this study may aid in the identification of SLE manifestations and improve medication management post-ESRD. METHODS We performed a retrospective cohort study of SLE patients with incident ESRD between 2010 and 2017. SLE-related symptoms, serologic markers of disease activity, and medication use were collected from medical records before and after ESRD development. RESULTS Fifty-nine patients were included in the study. Twenty-five (43%) patients had at least one clinical (non-renal) SLE manifestation documented within 12 months before ESRD. Of them, 11/25 (44%) continued to experience lupus symptoms post-ESRD; 9 patients without clinical or serological activity pre-ESRD developed new symptoms of active SLE. At the last documented visit post-ESRD, 42/59 (71%) patients had one or more clinical or serological markers of lupus activity; only 17/59 (29%) patients achieved clinical and serological remission. Thirty-three of 59 (56%) patients had an active HCQ prescription at the time of ESRD. Twenty-six of the 42 (62%) patients with active SLE manifestations post-ESRD were on HCQ. Patients who continued HCQ post-ESRD were more likely to be followed by a rheumatologist (26 [87%] vs 17 [61%], p = 0.024), had a higher frequency of documented arthritis (10 [32%] vs 1 [4%], p = 0.005), CNS manifestations (6 [20%] vs 1 [4%], p = 0.055), and concurrent immunosuppressive medication use (22 [71%] vs 12 [43%], p = 0.029). CONCLUSIONS Lupus activity may persist after the development of ESRD. New onset arthritis, lupus-related rash, CNS manifestations, low complement and elevated anti-dsDNA may develop. HCQ may be underutilized in patients with evidence of active disease pre- and post ESRD. Careful clinical and serological monitoring for signs of active disease and frequent rheumatology follow up is advised in SLE patients both, pre and post-ESRD.
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Affiliation(s)
- Maria Salgado Guerrero
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York USA
| | - Alejandra Londono Jimenez
- Division of Rheumatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York USA
| | - Chrisanna Dobrowolski
- Division of Rheumatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York USA
| | - Wenzhu B. Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
| | - Beatrice Goilav
- Division of Pediatric Nephrology, Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York USA
| | - Shudan Wang
- Division of Rheumatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York USA
| | - Anna Broder
- Division of Rheumatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York USA
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15
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Freilich BM, Feirsen N, Welton EI, Mowrey WB, Rubinstein TB. Validation of the Attention, Memory, and Frontal Abilities Screening Test (AMFAST). Assessment 2020; 27:1502-1514. [DOI: 10.1177/1073191118822734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study is to validate the Attention, Memory, and Frontal Abilities Screening Test (AMFAST), a novel, 10-minute, paper-and-pencil measure developed to identify attention, processing speed, memory, and executive functioning deficits in children and adults with various conditions characterized by frontal-subcortical dysfunction. We administered the AMFAST to 186 English-speaking healthy control participants (aged 8-88 years) without reported cognitive impairment. The AMFAST was also administered to a mixed clinical sample that included 114 English-speaking individuals (aged 8-84 years) who also received comprehensive neuropsychological testing. Results indicated that total AMFAST scores in the healthy control sample were not significantly affected by education or gender. There was, however, a significant effect of age, as the 8- to 10-year-old group scored significantly lower than other age groups. Thus, only participants 11+ years were included in further analyses. The AMFAST demonstrated high test–retest and interrater reliabilities, good construct validity, and the identified optimal cutoff score of 70 had excellent sensitivity and specificity for differentiating between cognitively intact and cognitively impaired individuals. These findings demonstrate that the AMFAST is a highly effective screening test that can be used to identify attention, memory, processing speed, and executive functioning deficits in individuals from middle childhood through older adulthood.
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Affiliation(s)
- Bryan M. Freilich
- Montefiore Medical Center, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Tamar B. Rubinstein
- Albert Einstein College of Medicine, Bronx, NY, USA
- The Children’s Hospital at Montefiore, Bronx, NY, USA
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16
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Chen W, Eisenberg R, Mowrey WB, Wylie-Rosett J, Abramowitz MK, Bushinsky DA, Melamed ML. Association between dietary zinc intake and abdominal aortic calcification in US adults. Nephrol Dial Transplant 2020; 35:1171-1178. [PMID: 31298287 PMCID: PMC7417001 DOI: 10.1093/ndt/gfz134] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/27/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In animal studies, zinc supplementation inhibited phosphate-induced arterial calcification. We tested the hypothesis that higher intake of dietary zinc was associated with lower abdominal aortic calcification (AAC) among adults in the USA. We also explored the associations of AAC with supplemental zinc intake, total zinc intake and serum zinc level. METHODS We performed cross-sectional analyses of 2535 participants from the National Health and Nutrition Examination Survey 2013-14. Dietary and supplemental zinc intakes were obtained from two 24-h dietary recall interviews. Total zinc intake was the sum of dietary and supplemental zinc. AAC was measured using dual-energy X-ray absorptiometry in adults ≥40 years of age and quantified using the Kauppila score system. AAC scores were categorized into three groups: no AAC (AAC = 0, reference group), mild-moderate (AAC >0-≤6) and severe AAC (AAC >6). RESULTS Dietary zinc intake (mean ± SE) was 10.5 ± 0.1 mg/day; 28% had AAC (20% mild-moderate and 8% severe), 17% had diabetes mellitus and 51% had hypertension. Higher intake of dietary zinc was associated with lower odds of having severe AAC. Per 1 mg/day higher intake of dietary zinc, the odds of having severe AAC were 8% lower [adjusted odds ratio 0.92 (95% confidence interval 0.86-0.98), P = 0.01] compared with those without AAC, after adjusting for demographics, comorbidities and laboratory measurements. Supplemental zinc intake, total zinc intake and serum zinc level were not associated with AAC. CONCLUSIONS Higher intake of dietary zinc was independently associated with lower odds of having severe AAC among noninstitutionalized US adults.
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Affiliation(s)
- Wei Chen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Ruth Eisenberg
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wenzhu B Mowrey
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Judith Wylie-Rosett
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Health Promotion and Nutrition Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - David A Bushinsky
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Michal L Melamed
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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17
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Hsia BC, Wu S, Mowrey WB, Jariwala SP. Evaluating the ASTHMAXcel Mobile Application Regarding Asthma Knowledge and Clinical Outcomes. Respir Care 2020; 65:1112-1119. [PMID: 32487751 DOI: 10.4187/respcare.07550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We sought to longitudinally assess the efficacy of the patient-facing ASTHMAXcel mobile application in improving asthma knowledge and outcomes in adults with asthma. METHODS ASTHMAXcel is a novel smartphone application consistent with the National Asthma Education and Prevention Program, Global Initiative for Asthma, and British Thoracic Society/Scottish Intercollegiate Guidelines Network guidelines. The intervention was provided for 1-time use at baseline only. The Asthma Knowledge Questionnaire (AKQ), the Asthma Control Test (ACT), and the mini-Asthma Quality of Life Questionnaire (mini-AQLQ) were administered at baseline and at 2, 4, and 6 months thereafter. Rates of asthma-related emergency department visits, hospitalizations, and prednisone use were also evaluated. RESULTS ACT scores increased significantly at 2, 4, and 6 months (mean scores: 15.1 vs 16.9, P = .038; 15.1 vs 17.2, P = .02; 15.1 vs 17.9, P = .003) after baseline. There were significant increases in AKQ scores at 4 and 6 months (11.7 vs 12.6, P = .02; 11.7 vs 13.1, P = .005) and in mini-AQLQ scores at 6 months (55.5 vs 64.2, P = .02). There were significant decreases in asthma-related emergency department visits at 6 months (0.6 vs 0, P < .001) and in hospitalizations at 4 and 6 months (0.3 vs 0.1, P = .02; 0.3 vs 0, P = .002). Prednisone use decreased at 4 and 6 months (1.2 vs 0.6, P = .01; 1.2 vs 0.3, P < .001). CONCLUSIONS ASTHMAXcel contributes to improved asthma knowledge and outcomes and to decreased health care utilization. ASTHMAXcel is an inexpensive, scalable aid for out-patient asthma management.
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Affiliation(s)
- Brian C Hsia
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Sammy Wu
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Wenzhu B Mowrey
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Sunit P Jariwala
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
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18
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De Sanctis P, Malcolm BR, Mabie PC, Francisco AA, Mowrey WB, Joshi S, Molholm S, Foxe JJ. Mobile Brain/Body Imaging of cognitive-motor impairment in multiple sclerosis: Deriving EEG-based neuro-markers during a dual-task walking study. Clin Neurophysiol 2020; 131:1119-1128. [PMID: 32200093 DOI: 10.1016/j.clinph.2020.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/03/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Individuals with a diagnosis of multiple sclerosis (MS) often present with cognitive and motor deficits, and thus the ability to perform tasks that rely on both domains may be particularly impaired. Yet, dual-task walking studies yield mixed results. Individual variance in the ability to cope with brain insult and mobilize additional brain resources may contribute to mixed findings. METHODS To test this hypothesis, we acquired event-related potentials (ERP) in individuals with MS and healthy controls (HCs) performing a Go/NoGo task while sitting (i.e., single task) or walking (i.e., dual-task) and looked at the relationship between task related modulation of the brain response and performance. RESULTS On the Go/NoGo task the MS group showed dual-task costs when walking, whereas HCs showed a dual-task benefit. Further, whereas the HC group showed modulation of the brain response as a function of task load, this was not the case in the MS group. Analysis for the pooled sample revealed a positive correlation between load-related ERP effects and dual-task performance. CONCLUSIONS These data suggest a neurophysiological marker of cognitive-motor dysfunction in MS. SIGNIFICANCE Understanding neural processes underlying dual-task walking will help identify objective brain measurements of real-world issues and may improve assessment of MS.
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Affiliation(s)
- Pierfilippo De Sanctis
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA; The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
| | - Brenda R Malcolm
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA
| | - Peter C Mabie
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ana A Francisco
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA
| | - Wenzhu B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sonja Joshi
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA
| | - Sophie Molholm
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA; The Dominick P. Purpura Department of Neuroscience, Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; The Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - John J Foxe
- The Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Van Etten Building - Wing 1C, 1225 Morris Park Avenue, Bronx, NY 10461, USA; The Dominick P. Purpura Department of Neuroscience, Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; The Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
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19
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Tan K, Meiri A, Mowrey WB, Abbott R, Goodrich JT, Sandler AL, Suri AK, Lipton ML, Wagshul ME. Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus: a matched case-control study. J Neurosurg 2019; 129:1611-1622. [PMID: 29350598 DOI: 10.3171/2017.6.jns162784] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 11/08/2016] [Accepted: 06/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe object of this study was to use diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) to characterize the long-term effects of hydrocephalus and shunting on white matter integrity and to investigate the relationship of ventricular size and alterations in white matter integrity with headache and quality-of-life outcome measures.METHODSPatients with shunt-treated hydrocephalus and age- and sex-matched healthy controls were recruited into the study and underwent anatomical and DTI imaging on a 3-T MRI scanner. All patients were clinically stable, had undergone CSF shunt placement before 2 years of age, and had a documented history of complaints of headaches. Outcome was scored based on the Headache Disability Inventory and the Hydrocephalus Outcome Questionnaire. Fractional anisotropy (FA) and other DTI-based measures (axial, radial, and mean diffusivity; AD, RD, and MD, respectively) were extracted in the corpus callosum and internal capsule with manual region-of-interest delineation and in other regions with TBSS. Paired t-tests, corrected with a 5% false discovery rate, were used to identify regions with significant differences between patients and controls. Within the patient group, linear regression models were used to investigate the relationship between FA or ventricular volume and outcome, as well as the effect of shunt-related covariates.RESULTSTwenty-one hydrocephalus patients and 21 matched controls completed the study, and their data were used in the final analysis. The authors found significantly lower FA for patients than for controls in 20 of the 48 regions, mostly posterior white matter structures, in periventricular as well as more distal tracts. Of these 20 regions, 17 demonstrated increased RD, while only 5 showed increased MD and 3 showed decreased AD. No areas of increased FA were observed. Higher FA in specific periventricular white matter tracts, tending toward FA in controls, was associated with increased ventricular size, as well as improved clinical outcome.CONCLUSIONSThe study shows that TBSS-based DTI is a sensitive technique for elucidating changes in white matter structures due to hydrocephalus and chronic CSF shunting and provides preliminary evidence that DTI may be a valuable tool for tailoring shunt procedures to monitor ventricular size following shunting and achieve optimal outcome, as well as for guiding the development of alternate therapies for hydrocephalus.
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Affiliation(s)
- Kristy Tan
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and
| | - Avital Meiri
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and
| | | | - Rick Abbott
- 3Department of Neurological Surgery, Children's Hospital at Montefiore; and
| | - James T Goodrich
- 3Department of Neurological Surgery, Children's Hospital at Montefiore; and
| | - Adam L Sandler
- 3Department of Neurological Surgery, Children's Hospital at Montefiore; and
| | - Asif K Suri
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and.,5Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Michael L Lipton
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and.,4Neuroscience.,5Department of Radiology, Montefiore Medical Center, Bronx, New York.,6Psychiatry and Behavioral Sciences, and
| | - Mark E Wagshul
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and.,7Physiology and Biophysics, Albert Einstein College of Medicine
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20
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Mowrey WB, Lipton RB, Katz MJ, Ramratan WS, Loewenstein DA, Zimmerman ME, Buschke H. Memory Binding Test Predicts Incident Dementia: Results from the Einstein Aging Study. J Alzheimers Dis 2019; 62:293-304. [PMID: 29439336 DOI: 10.3233/jad-170714] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/15/2022]
Abstract
BACKGROUND The Memory Binding Test (MBT) demonstrated good cross-sectional discriminative validity and predicted incident aMCI. OBJECTIVE To assess whether the MBT predicts incident dementia better than a conventional list learning test in a longitudinal community-based study. METHODS As a sub-study in the Einstein Aging Study, 309 participants age≥70 initially free of dementia were administered the MBT and followed annually for incident dementia for up to 13 years. Based on previous work, poor memory binding was defined using an optimal empirical cut-score of≤17 on the binding measure of the MBT, Total Items in the Paired condition (TIP). Cox proportional hazards models were used to assess predictive validity adjusting for covariates. We compared the predictive validity of MBT TIP to that of the free and cued selective reminding test free recall score (FCSRT-FR; cut-score:≤24) and the single list recall measure of the MBT, Cued Recalled from List 1 (CR-L1; cut-score:≤12). RESULTS Thirty-five of 309 participants developed incident dementia. When assessing each test alone, the hazard ratio (HR) for dementia was significant for MBT TIP (HR = 8.58, 95% CI: (3.58, 20.58), p < 0.0001), FCSRT-FR (HR = 4.19, 95% CI: (1.94, 9.04), p = 0.0003) and MBT CR-L1 (HR = 2.91, 95% CI: (1.37, 6.18), p = 0.006). MBT TIP remained a significant predictor of dementia (p = 0.0002) when adjusting for FCSRT-FR or CR-L1. CONCLUSIONS Older adults with poor memory binding as measured by the MBT TIP were at increased risk for incident dementia. This measure outperforms conventional episodic memory measures of free and cued recall, supporting the memory binding hypothesis.
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Affiliation(s)
- Wenzhu B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy J Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wendy S Ramratan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA
| | - Molly E Zimmerman
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Herman Buschke
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
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21
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Wai JM, Aloezos C, Mowrey WB, Baron SW, Cregin R, Forman HL. Using clinical decision support through the electronic medical record to increase prescribing of high-dose parenteral thiamine in hospitalized patients with alcohol use disorder. J Subst Abuse Treat 2019; 99:117-123. [PMID: 30797383 DOI: 10.1016/j.jsat.2019.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 09/14/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with alcohol use disorder (AUD) are at an increased risk of developing Wernicke's encephalopathy (WE), a devastating and difficult diagnosis caused by thiamine deficiency. Even as AUD is present in up to 25% of hospitalized patients on medical floors, appropriate thiamine supplementation in the hospital setting remains inadequate. These patients are particularly susceptible to thiamine deficiency and subsequent WE due to both their alcohol use and active medical illnesses. The electronic medical record (EMR) has become ubiquitous in health care systems and can be used as a tool to improve the care of hospitalized patients. METHODS As a quality improvement initiative, we implemented a medication order panel in the EMR with autopopulated orders for thiamine dosing to increase the appropriate use of high-dose parenteral thiamine (HPT) for hospitalized patients with AUD. We conducted a retrospective cohort study of all inpatients with AUD who received an Addiction Psychiatry Consult Service consult three months before and after the EMR change. We compared the proportion of patients receiving HPT prior to consultation (primary outcome) and the length of stay (secondary outcome) between the historical control group and the EMR intervention group. RESULTS Patients in the EMR intervention group were significantly more likely to receive HPT than the historical control group (20.2% vs. 2.7%, p < 0.0001). This difference remained statistically significant when adjusted for potential confounders (OR: 9.89, 95% CI: [2.77, 35.34], p = 0.0004). There was a trend towards statistical significance that the intervention group had a higher likelihood of being prescribed any thiamine (76.6% vs. 64.6%, p = 0.06) and had a shorter length of stay (median (IQR): 3.8 (2.4, 7.0) vs. 4.6 (2.9, 7.8) days, p = 0.06). CONCLUSION These results indicate that providing autopopulated thiamine order panels for patients with AUD can be an effective method for specialty services to increase appropriate care practices without additional education or training for providers. Further research should consider the clinical outcomes of increasing HPT for patients with AUD.
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Affiliation(s)
- Jonathan M Wai
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 66, Office 3705, New York, NY 10032, USA; Division on Substance Use Disorders, New York State Psychiatric Institute, Unit 66, Office 3705, New York, NY 10032, USA; Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Christopher Aloezos
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Department of Psychiatry, NYU School of Medicine, One Park Avenue, New York, NY 10016, USA
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Sarah W Baron
- Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - Regina Cregin
- Department of Pharmacy, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - Howard L Forman
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
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22
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Broder A, Mowrey WB, Golestaneh L, Putterman C, Costenbader KH, Kim M. Methodological considerations in comparing access to Pre-emptive renal transplantation between SLE and other ESRD causes in the USRDS. Semin Arthritis Rheum 2019; 48:678-685. [PMID: 30064728 PMCID: PMC6291358 DOI: 10.1016/j.semarthrit.2018.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND We compared pre-emptive transplant rates between SLE and non-SLE end-stage renal disease (ESRD) from the U.S. Renal Data System (USRDS) and investigated the potential influence of frequency matching and primary ESRD causes in the non-SLE group. METHODS 4830 adult SLE patients with incident ESRD from USRDS 2005-2009 were frequency matched by age, sex and race to 4830 patients with incident non-SLE ESRD. Multivariable logistic regression models were used to estimate the odds of pre-emptive transplantation in SLE and non-SLE, and with the non-SLE subgroups by primary ESRD cause. RESULTS The odds ratios (OR) of receiving a pre-emptive transplant were similar among non-SLE and SLE (referent group): OR = 1.18 (95% CI: 0.92, 1.50; p = 0.20). However, the ORs for receiving a pre-emptive transplant were 0.19 (95% CI: 0.08, 0.42) in type 2 diabetes ESRD, 0.42 (95% CI: 0.23, 0.75) for hypertension-associated ESRD, 1.67 (95% CI: 1.10, 2.54) in type 1 diabetes ESRD, and 2.06 (95% CI: 1.55, 2.73) for "other" ESRD. In contrast to non-SLE, younger SLE patients were less likely to receive a pre-emptive transplant than older SLE patients. CONCLUSION The results of this study provide compelling evidence that major improvements need to be made in optimizing access to pre-emptive transplantation in SLE by addressing sociodemographic disparities and the unique challenges faced by SLE patients. Applying careful matching and selecting appropriate comparison groups in future studies may facilitate the development of effective strategies to address these barriers and to increase the number of pre-emptive renal transplants among SLE patients.
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Affiliation(s)
- Anna Broder
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States.
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.
| | - Ladan Golestaneh
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States.
| | - Chaim Putterman
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.
| | - Karen H Costenbader
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.
| | - Mimi Kim
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.
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Londoño Jimenez A, Mowrey WB, Putterman C, Buyon J, Goilav B, Broder A. Brief Report: Tubulointerstitial Damage in Lupus Nephritis: A Comparison of the Factors Associated With Tubulointerstitial Inflammation and Renal Scarring. Arthritis Rheumatol 2018; 70:1801-1806. [PMID: 29851285 DOI: 10.1002/art.40575] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/24/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To characterize and compare the factors associated with tubulointerstitial inflammation (TII) and tubulointerstitial scarring, defined as interstitial fibrosis and/or tubular atrophy (IF/TA), in patients with lupus nephritis (LN). METHODS We identified systemic lupus erythematosus patients who had renal biopsy results consistent with LN between 2005 and 2017. Clinical data were collected from medical records. Multivariable logistic regression models were fitted to assess factors associated with TII and with IF/TA (moderate-to-severe versus none/mild). RESULTS Of 203 LN patients included, 41 (20%) had moderate-to-severe TII, 45 (22%) had moderate-to-severe IF/TA, and 21 (10%) had both. Multivariable logistic regression models showed that moderate-to-severe TII was associated with a shorter disease duration, African American race, proliferative LN, and an estimated glomerular filtration rate (eGFR) of <60 ml/minute/1.73 m2 at the time of biopsy. Hydroxychloroquine use was associated with significantly lower odds of moderate-to-severe TII (odds ratio 0.27 [95% confidence interval 0.10-0.70], P = 0.008). Similar to TII, factors associated with moderate-to-severe IF/TA included proliferative LN and eGFR <60 ml/minute/1.73 m2 at the time of biopsy. In addition, the presence of moderate-to-severe TII and older age was associated with moderate-to-severe IF/TA. None of the routinely available serologic markers-including anti-double-stranded DNA antibodies, anti-Ro/La antibodies, and low complement-were associated with tubulointerstitial damage. CONCLUSION The use of hydroxychloroquine was strongly associated with less inflammation, while the presence of TII, proliferative LN, and low eGFR were major determinants of tubulointerstitial scarring. Identifying modifiable factors is critical for the development of better preventive and therapeutic strategies with the goal of improving survival in patients with lupus-related kidney disease.
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Affiliation(s)
| | | | | | - Jill Buyon
- New York University School of Medicine, New York, New York
| | - Beatrice Goilav
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Anna Broder
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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24
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Kessler A, Campo JJ, Harawa V, Mandala WL, Rogerson SJ, Mowrey WB, Seydel KB, Kim K. Convalescent Plasmodium falciparum-specific seroreactivity does not correlate with paediatric malaria severity or Plasmodium antigen exposure. Malar J 2018; 17:178. [PMID: 29695240 PMCID: PMC5918990 DOI: 10.1186/s12936-018-2323-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 12/28/2017] [Accepted: 04/18/2018] [Indexed: 12/17/2022] Open
Abstract
Background Antibody immunity is thought to be essential to prevent severe Plasmodium falciparum infection, but the exact correlates of protection are unknown. Over time, children in endemic areas acquire non-sterile immunity to malaria that correlates with development of antibodies to merozoite invasion proteins and parasite proteins expressed on the surface of infected erythrocytes. Results A 1000 feature P. falciparum 3D7 protein microarray was used to compare P. falciparum-specific seroreactivity during acute infection and 30 days after infection in 23 children with uncomplicated malaria (UM) and 25 children with retinopathy-positive cerebral malaria (CM). All children had broad P. falciparum antibody reactivity during acute disease. IgM reactivity decreased and IgG reactivity increased in convalescence. Antibody reactivity to CIDR domains of “virulent” PfEMP1 proteins was low with robust reactivity to the highly conserved, intracellular ATS domain of PfEMP1 in both groups. Although children with UM and CM differed markedly in parasite burden and PfEMP1 exposure during acute disease, neither acute nor convalescent PfEMP1 seroreactivity differed between groups. Greater seroprevalence to a conserved Group A-associated ICAM binding extracellular domain was observed relative to linked extracellular CIDRα1 domains in both case groups. Pooled immune IgG from Malawian adults revealed greater reactivity to PfEMP1 than observed in children. Conclusions Children with uncomplicated and cerebral malaria have similar breadth and magnitude of P. falciparum antibody reactivity. The utility of protein microarrays to measure serological recognition of polymorphic PfEMP1 antigens needs to be studied further, but the study findings support the hypothesis that conserved domains of PfEMP1 are more prominent targets of cross reactive antibodies than variable domains in children with symptomatic malaria. Protein microarrays represent an additional tool to identify cross-reactive Plasmodium antigens including PfEMP1 domains that can be investigated as strain-transcendent vaccine candidates. Electronic supplementary material The online version of this article (10.1186/s12936-018-2323-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Kessler
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Visopo Harawa
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, Biomedical Department, University of Malawi, Blantyre, Malawi
| | - Wilson L Mandala
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, Biomedical Department, University of Malawi, Blantyre, Malawi.,Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi
| | | | | | - Karl B Seydel
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA. .,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.
| | - Kami Kim
- Albert Einstein College of Medicine, Bronx, NY, USA. .,Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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25
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Rubinstein TB, Mowrey WB, Ilowite NT, Wahezi DM. Delays to Care in Pediatric Lupus Patients: Data From the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry. Arthritis Care Res (Hoboken) 2018; 70:420-427. [PMID: 28544820 DOI: 10.1002/acr.23285] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/16/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Prompt treatment for lupus is important to prevent morbidity. A potential barrier to early treatment of pediatric lupus is delayed presentation to a pediatric rheumatologist. To better understand factors contributing to delayed presentation among pediatric lupus patients, we examined differences in demographic and clinical characteristics of lupus patients within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry with regard to time between symptom onset and presentation to a pediatric rheumatologist. METHODS We analyzed data from 598 CARRA Legacy Registry participants for differences between those who presented early (within <1 month of symptom onset), between 1-3 months (typical presentation), with moderate delays (3-12 months), and with severe delays (≥1 year). Factors associated with early presentation, moderate delay, and severe delay were determined by multinomial logistic regression. RESULTS Forty-four percent of patients presented early, while 23% had moderate delays and 9% had severe delays. Family history of lupus, absence of discoid rash, and location in a state with a higher density of pediatric rheumatologists were associated with earlier presentation. Younger age, low household income (<$25,000 per year), and a family history of lupus were associated with severe delay. CONCLUSION Delays to care ≥1 year exist in a notable minority of pediatric lupus patients from the CARRA Legacy Registry. In this large and diverse sample of patients, access to care and family resources played an important role in predicting time to presentation to a pediatric rheumatologist.
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Affiliation(s)
- Tamar B Rubinstein
- Albert Einstein College of Medicine and Children's Hospital at Montfiore, Bronx, New York
| | | | - Norman T Ilowite
- Albert Einstein College of Medicine and Children's Hospital at Montfiore, Bronx, New York
| | - Dawn M Wahezi
- Albert Einstein College of Medicine and Children's Hospital at Montfiore, Bronx, New York
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26
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Kessler A, Dankwa S, Bernabeu M, Harawa V, Danziger SA, Duffy F, Kampondeni SD, Potchen MJ, Dambrauskas N, Vigdorovich V, Oliver BG, Hochman SE, Mowrey WB, MacCormick IJC, Mandala WL, Rogerson SJ, Sather DN, Aitchison JD, Taylor TE, Seydel KB, Smith JD, Kim K. Linking EPCR-Binding PfEMP1 to Brain Swelling in Pediatric Cerebral Malaria. Cell Host Microbe 2017; 22:601-614.e5. [PMID: 29107642 DOI: 10.1016/j.chom.2017.09.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/06/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
Brain swelling is a major predictor of mortality in pediatric cerebral malaria (CM). However, the mechanisms leading to swelling remain poorly defined. Here, we combined neuroimaging, parasite transcript profiling, and laboratory blood profiles to develop machine-learning models of malarial retinopathy and brain swelling. We found that parasite var transcripts encoding endothelial protein C receptor (EPCR)-binding domains, in combination with high parasite biomass and low platelet levels, are strong indicators of CM cases with malarial retinopathy. Swelling cases presented low platelet levels and increased transcript abundance of parasite PfEMP1 DC8 and group A EPCR-binding domains. Remarkably, the dominant transcript in 50% of swelling cases encoded PfEMP1 group A CIDRα1.7 domains. Furthermore, a recombinant CIDRα1.7 domain from a pediatric CM brain autopsy inhibited the barrier-protective properties of EPCR in human brain endothelial cells in vitro. Together, these findings suggest a detrimental role for EPCR-binding CIDRα1 domains in brain swelling.
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Affiliation(s)
- Anne Kessler
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA
| | - Selasi Dankwa
- Center for Infectious Disease Research, Seattle, WA 98109, USA
| | - Maria Bernabeu
- Center for Infectious Disease Research, Seattle, WA 98109, USA
| | - Visopo Harawa
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre BT3, Malawi; University of Malawi, College of Medicine, Biomedical Department, Blantyre BT3, Malawi
| | | | - Fergal Duffy
- Center for Infectious Disease Research, Seattle, WA 98109, USA
| | | | - Michael J Potchen
- Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA
| | | | | | - Brian G Oliver
- Center for Infectious Disease Research, Seattle, WA 98109, USA
| | - Sarah E Hochman
- Department of Medicine, New York University Langone Health, New York, NY 10016, USA
| | - Wenzhu B Mowrey
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA
| | - Ian J C MacCormick
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre BT3, Malawi; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; Department of Eye and Vision Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Wilson L Mandala
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre BT3, Malawi; University of Malawi, College of Medicine, Biomedical Department, Blantyre BT3, Malawi; Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo BT3, Malawi
| | - Stephen J Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, VIC 3000, Australia
| | - D Noah Sather
- Center for Infectious Disease Research, Seattle, WA 98109, USA
| | | | - Terrie E Taylor
- Blantyre Malaria Project, Blantyre BT3, Malawi; Department of Osteopathic Medical Specialities, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Karl B Seydel
- Blantyre Malaria Project, Blantyre BT3, Malawi; Department of Osteopathic Medical Specialities, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | - Joseph D Smith
- Center for Infectious Disease Research, Seattle, WA 98109, USA; Department of Global Health, University of Washington, Seattle, WA 98195, USA.
| | - Kami Kim
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA.
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27
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Madaline TF, Hochman SE, Seydel KB, Liomba A, Saidi A, Matebule G, Mowrey WB, O'Hare B, Milner DA, Kim K. Rapid Diagnostic Testing of Hospitalized Malawian Children Reveals Opportunities for Improved HIV Diagnosis and Treatment. Am J Trop Med Hyg 2017; 97:1929-1935. [PMID: 29141709 DOI: 10.4269/ajtmh.17-0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Recent World Health Organization (WHO) guidelines recommend antiretroviral therapy (ART) for all HIV-infected people; previously CD4+ T lymphocyte quantification (CD4 count) or clinical staging determined eligibility for children ≥ 5 years old in low- and middle-income countries. We examined positive predictive value (PPV) of a rapid diagnostic test (RDT) algorithm and ART eligibility for hospitalized children with newly diagnosed HIV infection. We enrolled 363 hospitalized Malawian children age 2 months to 16 years with two serial positive HIV RDT from 2013 to 2015. Children aged ≤ 18 months whose nucleic acid testing was negative or unavailable were later excluded from the analysis (N = 16). If RNA PCR was undetectable, human immunodeficiency virus (HIV) enzyme immunoassay (EIA) and western blot (WB) were performed. Those with negative or discordant EIA and WB were considered HIV negative and excluded from further analysis (N = 6). ART eligibility was assessed using age, CD4 count, and clinical HIV stage. Among 150 patients with HIV RNA PCR results, 15 had undetectable HIV RNA. Of those, EIA and WB were positive in nine patients and negative or discordant in six patients. PPV of serial RDT was 90% versus RNA PCR alone and 96% versus combined RNA PCR, EIA, and WB. Of all patients aged ≥ 5 years, 8.9% were ineligible for ART under previous WHO guidelines. Improved HIV testing algorithms are needed for accurate diagnosis of HIV infection in children as prevalence of pediatric HIV declines. Universal treatment will significantly increase the numbers of older children who qualify for ART.
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Affiliation(s)
- Theresa F Madaline
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Sarah E Hochman
- Department of Medicine, New York University Langone Medical Center and New York University School of Medicine, New York, New York
| | - Karl B Seydel
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
| | - Alice Liomba
- Department of Paediatrics and Child Health, University of Malawi College of Medicine, Blantyre, Malawi.,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Alex Saidi
- Department of Paediatrics and Child Health, University of Malawi College of Medicine, Blantyre, Malawi.,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Grace Matebule
- Department of Paediatrics and Child Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Wenzhu B Mowrey
- Department of Epidemiology & Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Bernadette O'Hare
- Global Health Implementation, University of St. Andrews School of Medicine, North Haugh, United Kingdom.,Department of Paediatrics and Child Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois
| | - Kami Kim
- Departments of Pathology and Microbiology and Immunology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.,Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
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28
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Buschke H, Mowrey WB, Ramratan WS, Zimmerman ME, Loewenstein DA, Katz MJ, Lipton RB. Memory Binding Test Distinguishes Amnestic Mild Cognitive Impairment and Dementia from Cognitively Normal Elderly. Arch Clin Neuropsychol 2017; 32:1037-1038. [PMID: 28981569 DOI: 10.1093/arclin/acx046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Broder A, Mowrey WB, Khan HN, Jovanovic B, Londono-Jimenez A, Izmirly P, Putterman C. Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study. Semin Arthritis Rheum 2017; 47:545-551. [PMID: 28803673 DOI: 10.1016/j.semarthrit.2017.07.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The presence of tubulointerstitial damage (TID) on renal biopsy is considered to be a late sequela of lupus nephritis (LN). The objective of this study was to determine if TID predicts progression to end stage renal disease (ESRD) in LN patients without advanced kidney disease. METHODS All SLE patients with an index biopsy consistent with LN between January 2005 and July 2015, and eGFR ≥ 30mL/min/1.73m2 were included. Moderate-to-severe TID was defined as the presence of moderate-to-severe tubular atrophy and/or interstitial fibrosis. Time to ESRD was defined as time from the index biopsy date to incident ESRD date; non-ESRD patients were censored at the time of death or the last visit before December 2015. Time-dependent analyses were conducted to evaluate whether moderate-to-severe TID was predictive of ESRD progression. RESULTS Of the 131 LN patients with eGFR ≥ 30mL/min/1.73m2, 17 (13%) patients progressed to ESRD. Moderate-to-severe TID was present in 13% of biopsies with eGFR ≥ 60mL/min/1.73m2 and in 33% of biopsies with eGFR between 30 and 60mL/min/1.73m2. Moderate-to-severe TID was associated with a higher risk of ESRD progression: adjusted hazard ratio (HR) = 4.1, 95% CI: 1.4-12.1, p = 0.01 for eGFR ≥ 30mL/min/1.73m2; HR = 6.2, 95% CI: 1.7-23.2, p = 0.008 for eGFR ≥ 60mL/min/1.73m2. There was no association between tubulointerstitial inflammation (TII) and ESRD progression. CONCLUSIONS Moderate-to-severe TID, but not TII, was a strong predictor of ESRD progression independent of eGFR or glomerular findings, therefore, providing an important window for potential early interventions.
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Affiliation(s)
- Anna Broder
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Hina N Khan
- Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Bojana Jovanovic
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | | | - Peter Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Chaim Putterman
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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30
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Shusterman M, Golub E, Mowrey WB, Broder A. The association between ABO blood types and venous thromboembolism in individuals with a positive antiphospholipid profile is varied by sex. Lupus 2017; 27:319-326. [DOI: 10.1177/0961203317721352] [Citation(s) in RCA: 6] [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: 01/15/2023]
Affiliation(s)
- M Shusterman
- Department of Medicine, Montefiore Medical Center, New York, USA
| | - E Golub
- Department of Medicine, Montefiore Medical Center, New York, USA
| | - W B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, USA
| | - A Broder
- Division of Rheumatology, Montefiore Medical Center, New York, USA
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31
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Broder A, Mowrey WB, Izmirly P, Costenbader KH. Validation of Systemic Lupus Erythematosus Diagnosis as the Primary Cause of Renal Failure in the US Renal Data System. Arthritis Care Res (Hoboken) 2017; 69:599-604. [PMID: 27390299 DOI: 10.1002/acr.22972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/20/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Using American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria for systemic lupus erythematosus (SLE) classification as gold standards, we determined sensitivity, specificity, positive and negative predictive values (PPV and NPV) of having SLE denoted as the primary cause of end-stage renal disease (ESRD) in the US Renal Data System (USRDS). METHODS ESRD patients were identified by International Classification of Diseases, Ninth Revision codes in electronic medical records of 1 large tertiary care center, Montefiore Hospital, from 2006 to 2012. Clinical data were extracted and reviewed to establish SLE diagnosis. Data were linked by social security number, name, and date of birth to the USRDS, where primary causes of ESRD were ascertained. RESULTS Of 7,396 ESRD patients at Montefiore, 97 met ACR/SLICC SLE criteria, and 86 had SLE by record only. Among the 97 SLE patients, the attributed causes of ESRD in the USRDS were 77 SLE and 12 with other causes (unspecified glomerulonephritis, hypertension, scleroderma), and 8 missing. Sensitivity, specificity, PPV, and NPV for SLE in the USRDS were 79%, 99.9%, 93%, and 99.7%, respectively. Of the 60 patients with biopsy-proven lupus nephritis, 44 (73%) had SLE as primary ESRD cause in the USRDS. Attribution of the primary ESRD causes among SLE patients with ACR/SLICC criteria differed by race, ethnicity, and transplant status. CONCLUSION The diagnosis of SLE as the primary cause of ESRD in the USRDS has good sensitivity, and excellent specificity, PPV, and NPV. Nationwide access to medical records and biopsy reports may significantly improve sensitivity of SLE diagnosis.
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Affiliation(s)
- Anna Broder
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | | | | | - Karen H Costenbader
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
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32
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Mowrey WB, Lipton RB, Katz MJ, Ramratan WS, Loewenstein DA, Zimmerman ME, Buschke H. Memory Binding Test Predicts Incident Amnestic Mild Cognitive Impairment. J Alzheimers Dis 2017; 58:951-952. [DOI: 10.3233/jad-179003] [Citation(s) in RCA: 2] [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: 11/15/2022]
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33
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Malcolm BR, Foxe JJ, Butler JS, Mowrey WB, Molholm S, De Sanctis P. Long-term test-retest reliability of event-related potential (ERP) recordings during treadmill walking using the mobile brain/body imaging (MoBI) approach. Brain Res 2017; 1716:62-69. [PMID: 28532853 DOI: 10.1016/j.brainres.2017.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 12/14/2016] [Revised: 04/19/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
Advancements in acquisition technology and signal-processing techniques have spurred numerous recent investigations on the electro-cortical signals generated during whole-body motion. This approach, termed Mobile Brain/Body Imaging (MoBI), has the potential to elucidate the neural correlates of perceptual and cognitive processes during real-life activities, such as locomotion. However, as of yet, no one has assessed the long-term stability of event-related potentials (ERPs) recorded under these conditions. Therefore, the objective of the current study was to evaluate the test-retest reliability of cognitive ERPs recorded while walking. High-density EEG was acquired from 12 young adults on two occasions, separated by an average of 2.3years, as they performed a Go/No-Go response inhibition paradigm. During each testing session, participants performed the task while walking on a treadmill and seated. Using the intraclass correlation coefficient (ICC) as a measure of agreement, we focused on two well-established neurophysiological correlates of cognitive control, the N2 and P3 ERPs. Following ICA-based artifact rejection, the earlier N2 yielded good to excellent levels of reliability for both amplitude and latency, while measurements for the later P3 component were generally less robust but still indicative of adequate to good levels of stability. Interestingly, the N2 was more consistent between walking sessions, compared to sitting, for both hits and correct rejection trials. In contrast, the P3 waveform tended to have a higher degree of consistency during sitting conditions. Overall, these results suggest that the electro-cortical signals obtained during active walking are representative of stable indices of neurophysiological function.
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Affiliation(s)
- Brenda R Malcolm
- The Sheryl & Daniel R. Tishman Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Program in Cognitive Neuroscience, The Graduate Center of the City University of New York, New York, NY 10016, USA
| | - John J Foxe
- The Sheryl & Daniel R. Tishman Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Program in Cognitive Neuroscience, The Graduate Center of the City University of New York, New York, NY 10016, USA; The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA; The Dominick P. Purpura Department of Neuroscience, Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Trinity College Institute of Neuroscience, Dublin, Ireland.
| | - John S Butler
- The Sheryl & Daniel R. Tishman Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Trinity College Institute of Neuroscience, Dublin, Ireland; Trinity College Dublin, Centre for Bioengineering, Trinity Biomedical Sciences Institute, Dublin, Ireland; School of Mathematical Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Wenzhu B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Sophie Molholm
- The Sheryl & Daniel R. Tishman Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Program in Cognitive Neuroscience, The Graduate Center of the City University of New York, New York, NY 10016, USA; The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA; The Dominick P. Purpura Department of Neuroscience, Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Pierfilippo De Sanctis
- The Sheryl & Daniel R. Tishman Cognitive Neurophysiology Laboratory, Children's Evaluation and Rehabilitation Center (CERC), Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Program in Cognitive Neuroscience, The Graduate Center of the City University of New York, New York, NY 10016, USA; The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Galanopoulou AS, Mowrey WB, Liu W, Li Q, Shandra O, Moshé SL. Preclinical Screening for Treatments for Infantile Spasms in the Multiple Hit Rat Model of Infantile Spasms: An Update. Neurochem Res 2017; 42:1949-1961. [PMID: 28462453 DOI: 10.1007/s11064-017-2282-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 12/16/2022]
Abstract
Infantile spasms are the typical seizures of West syndrome, an infantile epileptic encephalopathy with poor outcomes. There is an increasing need to identify more effective and better tolerated treatments for infantile spasms. We have optimized the rat model of infantile spasms due to structural etiology, the multiple-hit rat model, for therapy discovery. Here, we test three compounds administered after spasms induction in the multiple hit model for efficacy and tolerability. Specifically, postnatal day 3 (PN3) male Sprague-Dawley rats were induced by right intracerebral injections of doxorubicin and lipopolysaccharide. On PN5 p-chlorophenylalanine was given intraperitoneally (i.p.). Daily monitoring of weights and developmental milestones was done and rats were intermittently video monitored. A blinded, randomized, vehicle-controlled study design was followed. The caspase 1 inhibitor VX-765 (50-200 mg/kg i.p.) and the GABAB receptor inhibitor CGP35348 (12.5-100 mg/kg i.p.) each was administered in different cohorts as single intraperitoneal injections on PN4, using a dose- and time-response design with intermittent monitoring till PN5. 17β-estradiol (40 ng/g/day subcutaneously) was given daily between PN3-10 and intermittent monitoring was done till PN12. None of the treatments demonstrated acute or delayed effects on spasms, yet all were well tolerated. We discuss the implications for therapy discovery and challenges of replication trials.
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Affiliation(s)
- Aristea S Galanopoulou
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx, NY, USA.
- Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Center, Albert Einstein College of Medicine, 1410 Pelham Parkway South, Kennedy Center Rm 306, Bronx, NY, 10461, USA.
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wei Liu
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qianyun Li
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Oleksii Shandra
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx, NY, USA
- Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Center, Albert Einstein College of Medicine, 1410 Pelham Parkway South, Kennedy Center Rm 306, Bronx, NY, 10461, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
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Nariai H, Beal J, Galanopoulou AS, Mowrey WB, Bickel S, Sogawa Y, Jehle R, Shinnar S, Moshé SL. Scalp EEG Ictal gamma and beta activity during infantile spasms: Evidence of focality. Epilepsia 2017; 58:882-892. [PMID: 28397999 DOI: 10.1111/epi.13735] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We investigated temporal and spatial characteristics of ictal gamma and beta activity on scalp EEG during spasms in patients with West syndrome (WS) to evaluate potential focal cortical onset. METHODS A total of 1,033 spasms from 34 patients with WS of various etiologies were analyzed on video-electroencephalography (EEG) using time-frequency analysis. Ictal gamma (35-90 Hz) and beta (15-30 Hz) activities were correlated with visual symmetry of spasms, objective EMG (electromyography) analysis, and etiology of WS. RESULTS Prior to the ictal motor manifestation, focal ictal gamma activity emerged from one hemisphere (71%, 24/34) or from midline (26%, 9/34), and was rarely simultaneously bilateral (3%, 1/34). Focal ictal beta activity emerged from either one hemisphere (68%, 23/34) or from midline (32%, 11/34). Onsets of focal ictal gamma and beta activity were most commonly observed around the parietal areas. Focal ictal gamma activity propagated faster than ictal beta activity to adjacent electrodes (median: 65 vs. 170 msec, p < 0.01), and to contralateral hemisphere (median: 100 vs. 170 msec, p = 0.01). Asymmetric peak amplitude of ictal gamma activity in the centroparietal areas (C3-P3 vs. C4-P4) correlated with asymmetric semiology. On the other hand, most of the visually symmetric spasms showed asymmetry in peak amplitude and interhemispheric onset latency difference in both ictal gamma and beta activity. SIGNIFICANCE Spasms may be a seizure with focal electrographic onset regardless of visual symmetry. Asymmetric involvement of ictal gamma activity to the centroparietal areas may determine the motor manifestations in WS. Scalp EEG ictal gamma and beta activity may be useful to demonstrate localized seizure onset in infants with WS.
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Affiliation(s)
- Hiroki Nariai
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Jules Beal
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Aristea S Galanopoulou
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Dominick P. Purpura Department Neuroscience, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Wenzhu B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Stephan Bickel
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Yoshimi Sogawa
- Department of Pediatrics and Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Rana Jehle
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Shlomo Shinnar
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Dominick P. Purpura Department Neuroscience, Albert Einstein College of Medicine, Bronx, New York, U.S.A
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Akenroye AT, Kumthekar AA, Alevizos MK, Mowrey WB, Broder A. Implementing an Electronic Medical Record-Based Reminder for Cardiovascular Risk Screening in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 69:625-632. [PMID: 27390217 DOI: 10.1002/acr.22966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/22/2016] [Accepted: 06/21/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Although cardiovascular disease (CVD) is the leading cause of death among individuals with rheumatoid arthritis (RA), CVD risks are not being assessed frequently and systematically in RA. We implemented an electronic medical record (EMR)-based reminder in a tertiary care center and assessed the effects of this intervention on CVD risk screening by rheumatologists and primary care providers. METHODS The EMR reminder was implemented in December 2013 and included the most recent value and target ranges for body mass index, blood pressure (BP), and lipid profiles. It was displayed for every rheumatology and primary care visit for all patients with the International Classification of Diseases, Ninth Revision code for RA (714.0). Lipid screening rates, as well as changes in BP and obesity rates were compared pre- and postimplementation. Factors associated with lipid screening postimplementation were assessed using multivariate logistic regression. RESULTS A total of 138 and 112 RA patients were seen in the outpatient clinics pre- and postimplementation, respectively. The demographic characteristics were similar in the pre- and postimplementation groups. Lipid screening rates were 50% preimplementation and 46% postimplementation (P = 0.58). There were no significant improvements in BP or obesity rates postimplementation. Factors associated with the higher odds of lipid screening included older age and history of diabetes mellitus. CONCLUSION Implementing an EMR reminder did not improve CVD risk screening among RA patients. Future research is needed to identify and address barriers to CVD screening, and to educate patients and providers about RA-related risks.
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Affiliation(s)
- Ayobami T Akenroye
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Anand A Kumthekar
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Michail K Alevizos
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Abstract
Preclinical studies have produced numerous drugs with antiseizure properties that currently are the standard of care. One third of the human population with epilepsy still continues to have seizures despite the ongoing discoveries. The recognized clinical gaps of care that need to be addressed are the identification of antiepileptogenic and disease‐modifying treatments, and treatments for refractory seizures or for seizures and epilepsies with limited or unsatisfactory treatments, such as early life epileptic encephalopathies. In this invited review, we provide a historical summary of the international efforts to reevaluate the strategies adopted in preclinical epilepsy therapy discovery studies. We discuss issues that may affect the quality, interpretation, and validation of preclinical studies and their translation to successful therapies for humans affected with epilepsy. These include the selection of animal models and the study design; research practices that affect rigor (such as appropriate use of statistics and reporting of study methods and results, their validation across models, labs, and preclinical‐clinical studies); the need to harmonize research methods and outcome assessment; and the importance of improving translation to clinically appropriate situations. The epilepsy research community is incrementally adopting collaborative research, including consortia or multicenter studies to meet these needs. Improving the infrastructure that can support these efforts will be instrumental in future success.
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Affiliation(s)
- Aristea S Galanopoulou
- Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Laboratory of Developmental Epilepsy, Montefiore / Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx NY USA
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx NY USA
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Buschke H, Mowrey WB, Ramratan WS, Zimmerman ME, Loewenstein DA, Katz MJ, Lipton RB. Memory Binding Test Distinguishes Amnestic Mild Cognitive Impairment and Dementia from Cognitively Normal Elderly. Arch Clin Neuropsychol 2016; 32:29-39. [PMID: 27680087 DOI: 10.1093/arclin/acw083] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 09/06/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE We aimed to assess reliability and cross-sectional discriminative validity of the Memory Binding Test (MBT) to distinguish persons with amnestic cognitive impairment (aMCI) and dementia from cognitively normal elderly controls. METHOD The MBT was administered to 20 participants with dementia, 31 with aMCI and 246 controls, who received the first administration of the MBT from May 2003 to December 2007, as a substudy of the community-based Einstein Aging Study (age range: 70+). The optimal index resulted from comparing the partial area under the receiver operating characteristic curves (ROC AUC) of four major MBT indices for specificities ≥0.70. Optimal cut-score of the optimal index was selected by maximizing the sum of sensitivity and specificity. Age and education effects were assessed using stratified cut-scores and adjusted logistic regression. Reliability was computed as intraclass correlation between scores at baseline and 1-year follow-up for participants who remained cognitively normal. RESULTS Total number of Items recalled in the Paired condition (TIP) was elected the optimal index. TIP cut-score was ≤22 for differentiating aMCI alone (sensitivity = 0.74, specificity = 0.73) and aMCI and dementia combined (sensitivity = 0.84, specificity = 0.73) from controls. It was ≤17 for differentiating dementia from aMCI and controls (sensitivity = 0.95, specificity = 0.87). Age and education adjustments did not materially improve discriminative validity. The reliability of TIP was 0.77. CONCLUSIONS MBT achieved moderate to good reliability. TIP had superior cross-sectional discriminative validity than the other MBT indices. We recommend using the empirical cut-score of TIP ≤22 for discriminating aMCI and dementia and ≤17 for discriminating dementia alone.
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Affiliation(s)
- Herman Buschke
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Wenzhu B Mowrey
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY 10461, USA .,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Wendy S Ramratan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Molly E Zimmerman
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136, USA
| | - Mindy J Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Mowrey WB, Lipton RB, Katz MJ, Ramratan WS, Loewenstein DA, Zimmerman ME, Buschke H. Memory Binding Test Predicts Incident Amnestic Mild Cognitive Impairment. J Alzheimers Dis 2016; 53:1585-1595. [DOI: 10.3233/jad-160291] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Wenzhu B. Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy J. Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wendy S. Ramratan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David A. Loewenstein
- Department of Psychiatry & Behavioral Sciences, University of Miami, Miami, FL, USA
| | - Molly E. Zimmerman
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Herman Buschke
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
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Broder A, Mowrey WB, Kim M, Murakhovskaya I, Billett H, Neugarten J, Costenbader KH, Putterman C. Association between antiphospholipid antibodies and all-cause mortality among end-stage renal disease patients with and without SLE: a retrospective cohort study. Rheumatology (Oxford) 2015; 55:817-25. [PMID: 26705328 DOI: 10.1093/rheumatology/kev423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 07/14/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the association between the presence of aPL and/or LA and all-cause mortality among end-stage renal disease (ESRD) patients with and without SLE. METHODS We included ESRD patients >18 years old followed at an urban tertiary care centre between 1 January 2006 and 31 January 2014 who had aPL measured at least once after initiating haemodialysis. All SLE patients met ACR/SLICC criteria. APL/LA+ was defined as aCL IgG or IgM >40 IU, anti-β2glycoprotein1 IgG or IgM >40 IU or LA+. Deaths as at 31 January 2014 were captured in the linked National Death Index data. Time to death was defined from the first aPL measurement. RESULTS We included 34 SLE ESRD and 64 non-SLE ESRD patients; 30 patients died during the study period. SLE ESRD patients were younger [40.4 (12.5) vs 51.9 (18.1) years, P = 0.001] and more were women (88.2% vs 54.7%, P < 0.001) vs non-SLE ESRD patients. The frequency of aPL/LA+ was 24% in SLE and 13% in non-SLE ESRD (P = 0.16). Median (inter-quartile range) follow-up time was 1.6 (0.3-3.5) years in SLE and 1.4 (0.4-3.2) years in non-SLE, P = 0.74. The adjusted hazard ratio (HR) for all-cause mortality for SLE patients who were aPL/LA+ vs aPL/LA- was 9.93 (95% CI 1.33, 74.19); the adjusted HR for non-SLE aPL/LA+ vs aPL/LA- was 0.77 (95% CI 0.14, 4.29). CONCLUSION SLE ESRD patients with aPL/LA+ had higher all-cause mortality risk than SLE ESRD patients without these antibodies, while the effects of aPL/LA on mortality were comparable among non-SLE ESRD patients.
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Affiliation(s)
- Anna Broder
- Division of Rheumatology, Department of Medicine,
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health
| | - Mimi Kim
- Division of Biostatistics, Department of Epidemiology and Population Health
| | | | | | - Joel Neugarten
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY and
| | - Karen H Costenbader
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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