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Marks E, Badia AA, Goldberg MS. Diagnostic utility of the 23-gene expression profile test for an atypical intradermal melanocytic proliferation. Per Med 2024; 21:21-27. [PMID: 38059357 DOI: 10.2217/pme-2023-0110] [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] [Indexed: 12/08/2023]
Abstract
Ancillary tests such as immunohistochemistry (IHC) and gene expression profile (GEP) testing may be needed to arrive at a definitive diagnosis for some atypical melanocytic neoplasms. A 34-year-old male with a family history of melanoma presented with a large, heterogeneous melanocytic lesion on the cheek. Histopathological review of two biopsies revealed an atypical intradermal melanocytic proliferation with spitzoid features without ulceration or regression. Scattered mitotic figures were identified. In addition to performing SOX10 IHC, PRAME and HMB45 staining highlighted weak, patchy positivity that was stronger in superficial, pleomorphic melanocytes (Ki-67, 5-7% mitotic rate). Based on these concerning but ambiguous IHC results and lingering concern for melanoma reiterated by other consulting dermatopathologists, the 23-GEP was requested for both specimens, which both returned a malignant result. The inconclusive histopathological features of malignancy were resolved by 23-GEP testing, facilitating a final diagnosis of malignant melanoma (pT3a, 2.5 mm Breslow depth, Clark's level IV).
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Affiliation(s)
- Etan Marks
- Department of Dermatopathology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology & Cosmetic Surgery, Oviedo, FL 32765, USA
| | - Anais A Badia
- Advanced Dermatology & Cosmetic Surgery, Fort Myers, FL 33907, USA
| | - Matthew S Goldberg
- Castle Biosciences, Inc., Friendswood, TX 77546, USA
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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2
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Wu DW, Jacobson J, Lifshitz M, Li Y, Lyu C, Friedmann R, Walsh R, Himchak E, Mohandas K, Karim S, Marks E, Himchak SH, Hilbert T. A retrospective study for association between post-transfusion hemoglobin S level and pre-transfusion hemoglobin S level at the next scheduled transfusion. J Clin Apher 2023; 38:529-539. [PMID: 37198953 DOI: 10.1002/jca.22056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/12/2023] [Accepted: 04/30/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) frequently undergo prophylactic red blood cell (RBC) exchange transfusion and simple transfusion (RCE/T) to prevent complications of disease, such as stroke. These treatment procedures are performed with a target hemoglobin S (HbS) of ≤30%, or a goal of maintaining an HbS level of <30% immediately prior to the next transfusion. However, there is a lack of evidence-based instructions for how to perform RCE/T in a way that will result in an HbS value <30% between treatments. PRINCIPAL OBJECTIVE To determine whether targets for post-treatment HbS (post-HbS) or post-treatment HCT (post-HCT) can help to maintain an HbS <30% or <40% between treatments. MATERIALS AND METHODS We performed a retrospective study of patients with SCD treated with RCE/T at Montefiore Medical Center from June 2014 to June 2016. The analysis included patients of all ages, and data including 3 documented parameters for each RCE/T event: post-HbS, post-HCT, and follow-up HbS (F/u-HbS), which is the pre-treatment HbS prior to the next RCE/T. Generalized linear mixed model was used for estimating the association between post-HbS or post-HCT levels and F/u-HbS <30%. RESULTS Based on our results, targeting post-HbS ≤10% was associated with higher odds of having events of F/u-HbS <30% between monthly treatments. Targeting post-HbS ≤15% was associated with higher odds of events of F/u-HbS < 40%. As compared to post-HCT ≤30%, a post-HCT >30%-36% did not contribute to more F/u-HbS <30% or HbS <40% events. CONCLUSIONS For patients with SCD undergoing regular RCE/T for stroke prevention, a post-HbS ≤10% can be used as a goal to help maintain an HbS <30% for 1 month, and a post-HbS ≤15% allowed patients to maintain HbS <40%.
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Affiliation(s)
- Ding Wen Wu
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, USA
| | - Jessica Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, USA
| | - Mark Lifshitz
- Department of Pathology, Molecular and Cell-Based Medicine, Division of Clinical Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yanhua Li
- Division of Transfusion Medicine, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Chen Lyu
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Rachel Friedmann
- Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, New York, USA
| | - Ronald Walsh
- Albert Einstein School of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | | | | | - Sadiqa Karim
- Westchester Medical Center, Valhalla, New York, USA
| | - Etan Marks
- Kansas City University-Graduate Medical Education Consortium/ Advanced Dermatology and Cosmetic Surgery, Oviedo, Florida, USA
| | | | - Timothy Hilbert
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, USA
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3
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Marks E, Jarell A, Ludzik J, Farberg AS, Rabinovitz HS, Phelps RG, Cockerell CJ, Witkowski A. A Physician's Guide to the Use of Gene Expression Profile Ancillary Diagnostic Testing for Cutaneous Melanocytic Neoplasms. J Clin Aesthet Dermatol 2023; 16:12-20. [PMID: 37077930 PMCID: PMC10110288] [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] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Objectives Some melanocytic neoplasms suspicious for melanoma require additional workup to arrive at a final diagnosis. Within the last eight years, gene expression profiling (GEP) has become an important ancillary tool to aid in the diagnosis of melanocytic neoplasms with uncertain malignant potential. As the usage of two commercially available tests (23-GEP and 35-GEP) evolves, it is important to answer key questions about optimal utilization and their impact on patient care. Methods Recent and relevant articles answering the following questions were included in the review. First, how do dermatopathologists synthesize the available literature, the latest guidelines, and their clinical experience to determine which cases would be most likely to benefit from GEP testing? Second, how best can a dermatologist convey to their dermatopathologist that the use of GEP in the diagnostic process could provide a more clearly defined result and thereby help empower the dermatologist to provide higher-quality patient care when making specific patient management decisions for otherwise pathologically ambiguous lesions? Results When interpreted in the context of the clinical, pathologic, and laboratory information, GEP results can facilitate the rendering of timely, accurate, and definitive diagnoses for melanocytic lesions with otherwise uncertain malignant potential to inform personalized treatment and management plans. Limitations This was a narrative review focused on clinical use of GEP compared to other ancillary diagnostic tests performed postbiopsy. Conclusion Open communication between dermatopathologists and dermatologists, especially regarding GEP testing, can be a vital component to achieve appropriate clinicopathologic correlation for otherwise ambiguous melanocytic lesions.
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Affiliation(s)
- Etan Marks
- Dr. Marks is with Dermatopathology, Kansas City University-Graduate Medical Education Consortium in Oviedo, Florida, and Advanced Dermatology and Cosmetic Surgery in Oviedo, Florida
| | - Abel Jarell
- Dr. Jarell is with Granite State Dermatology, PC in Portsmouth, New Hampshire
| | - Joanna Ludzik
- Drs. Ludzik and Witkowski are with the Department of Dermatology, Oregon Health & Science University in Portland, Oregon
- Dr. Ludzik is also with the Department of Telemedicine and Bioinformatics, Jagiellonian University Medical College in Krakow, Poland
| | - Aaron S. Farberg
- Dr. Farberg is with Baylor Scott & White Health System in Dallas, Texas
| | - Harold S. Rabinovitz
- Dr. Rabinovitz is with the Department of Dermatology, Medical College of Georgia in Augusta, Georgia
| | - Robert G. Phelps
- Dr. Phelps is with Mount Sinai Hospital in New York City, New York
| | - Clay J. Cockerell
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas and the Departments of Dermatology and Pathology, UT Southwestern Medical Center in Dallas, Texas
| | - Alexander Witkowski
- Drs. Ludzik and Witkowski are with the Department of Dermatology, Oregon Health & Science University in Portland, Oregon
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Marks E, Doyle K, Magennis B, O'Connell M, McGreevy C. 131 USE OF FDG-PET BRAIN IMAGING IN THE DIAGNOSIS AND MANAGEMENT OF DEMENTIA IN A UNIVERSITY HOSPITAL. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.110] [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: 11/13/2022] Open
Abstract
Abstract
Background
Neuroimaging is an increasingly important tool dementia work-up. Subtype diagnosis helps predict the course of the disease, aiding prognostication and management. Amyloid-beta peptide is intrinsic to the pathogenesis of Alzheimer’s disease (AD), forming characteristic neuritic plaques which can be imaged in vivo on positron emission tomography (PET) scans. NICE recommendations advise use of PET imaging if dementia sub-type diagnosis is unclear and AD is suspected. We sought to establish the referral patterns for FDG-PET brain scans for patients aged 60 and over in a university hospital and to establish whether this imaging modality contributed to a change in diagnosis or treatment.
Methods
Requests for FDG-PET CT brain from 2019 – 2022 were retrospectively reviewed. Information was obtained from clinical notes and patient information software. Patient demographics, indication for scan, source of referral and whether imaging results led to a change in diagnosis or treatment was recorded.
Results
A total of 32 patients were reviewed, with a mean age of 65 years (13 females; 41%). We further analysed the 25 who were aged over 60; this subgroup had a mean age of 70 (9 females; 36%). All 25 patients were appropriately referred to assess for dementia subtype. A revision in diagnosis based on PET imaging was made in 17 (68%) cases. In 9 (30%) cases, results prompted change in dementia-specific pharmacological treatment, including donepezil and memantine. A further 6 (24%) had pharmacological treatment for non-cognitive symptoms of dementia adjusted, such as anti-depressants or anti-psychotics. The majority of referrals had come from neurologists (n = 15; 60%) rather than geriatricians (n = 10; 40%). The final diagnosis was AD in 12 cases (48%) and fronto-temporal dementia in 3 cases (12%).
Conclusion
PET scans are a useful functional imaging modality which can help to differentiate dementia subtypes and influence management.
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Affiliation(s)
- E Marks
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - K Doyle
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - B Magennis
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - M O'Connell
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - C McGreevy
- Mater Misericordiae University Hospital , Dublin, Ireland
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Nyckowski T, Vance P, Marks E. A Case of Indeterminate Cutaneous Dendritic Cell Tumors in the Setting of Chronic Myelomonocytic Leukemia. Am J Dermatopathol 2022; 44:449-453. [PMID: 35385851 DOI: 10.1097/dad.0000000000002195] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Chronic myelomonocytic leukemia (CMML) is a rare hematopoietic stem cell neoplasm. Indeterminate dendritic cell neoplasm (IDCN) is an extraordinarily rare histiocytosis that may manifest secondarily to CMML. A 75-year-old man with a 2-year history of CMML presented for multiple cutaneous lesions on his head and neck. Biopsy results yielded a dense diffuse infiltrate of large pleomorphic cells, which were positive for CD1a, S100, and CD56 with weak positivity for CD43 and CD68. Given his history of CMML, the patient was diagnosed with IDCN. This may indicate a progression of his CMML or transformation to acute leukemia; therefore, a systemic workup was recommended. IDCN may manifest secondary to a wide number of hematopoietic malignancies, with CMML being a rare occurrence. Recorded responses to phototherapy are reassuring, whereas systemic therapy may be appropriate for widespread cases. Remaining vigilant for cutaneous changes in patients with CMML will help prevent misdiagnosis and encourage prompt initiation of appropriate treatment.
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Affiliation(s)
- Timothy Nyckowski
- Kansas City University Graduate Medical Education Consortium, Orlando Dermatology Residency, Advanced Dermatology and Cosmetic Surgery, Orlando, FL
| | | | - Etan Marks
- Kansas City University Graduate Medical Education Consortium, Orlando Dermatology Residency, Advanced Dermatology and Cosmetic Surgery, Orlando, FL
- Skin Pathology Associates Inc
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6
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Foss MG, Dunn C, Marks E, Nathoo R. Superficial solitary fibrous tumor masquerading as a dermoid cyst: a case report. AME Case Rep 2022; 6:34. [PMID: 36339907 PMCID: PMC9634459 DOI: 10.21037/acr-22-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022]
Abstract
Background Solitary fibrous tumors (SFTs) are relatively rare spindle cell neoplasms uncommonly seen in dermatology practice. Initially discovered as a pleural tumor, SFTs have also been found in extra-pleural sites including the skin and soft tissues. When arising within the dermis or subcutis they are termed superficial SFTs, where they often present as solitary, unilateral, slow growing superficial masses. Histologically, they are composed of spindle cells arranged in a “patternless” pattern with hemangiopericytoma-like vessels dispersed throughout. Historically, CD34, CD99 and Bcl-2 immunohistochemical (IHC) stains were used to differentiate SFTs from other spindle cell neoplasms, however these markers are not entirely specific. Recent discovery of a disease defining NGFI-A binding protein 2 (NAB2)-signal transducer and activator of transcription 6 (STAT6) fusion gene has led to the use of STAT6 IHC staining to help verify the diagnosis of SFTs, particularly in unexpected sites. Case Description We report a case of a 23-year-old woman with a slowly growing lateral supra-orbital mass, clinically concerning for a dermoid cyst, which was subsequently discovered to be a SFT on pathologic examination, with the diagnosis being verified by STAT6 immunostaining. Conclusions SFTs are rarely encountered in dermatologic practice, however, must be kept on the differential of subcutaneous nodules, including those occurring in young adults. Due to the rarity of these tumors in clinical practice, a proposed algorithm for the approach to management of SFTs is included, guided by a validated, histology-driven, metastatic risk assessment tool, to help guide other clinicians confronted by these tumors.
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Ambur AB, Nyckowski T, Marks E, Spanogle J. Collision of Basal Cell Carcinoma and Sebaceous Carcinoma Extirpated With Mohs Micrographic Surgery. Cureus 2021; 13:e18015. [PMID: 34667690 PMCID: PMC8520315 DOI: 10.7759/cureus.18015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/05/2022] Open
Abstract
Collision tumors are neoplasms composed of two or more distinct cellular lineages coexisting at the same anatomic site. Incomplete biopsy, partial pathological slide examination or failure to include this diagnosis into the clinical differential may complicate and delay appropriate therapy. Although collision tumors are well documented, basal cell carcinoma (BCC) occurring with sebaceous carcinoma (SC) has only been reported in a single case report. The aim of the authors is to present a case of collision BCC and SC to highlight a rare clinicopathological case. We also present this case to advise caution to detect mimickers of BCC that warrant greater clinical workup and use this case to emphasize the importance of Mohs micrographic surgery for the treatment of SC.
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Affiliation(s)
- Austin B Ambur
- Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery, Oviedo, USA
| | - Timothy Nyckowski
- Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery, Oviedo, USA
| | - Etan Marks
- Dermatopathology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery, Oviedo, USA
| | - Joshua Spanogle
- Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery, Oviedo, USA
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8
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Wong J, Mammino J, Seyffert J, Schmits K, Marks E, Rivlin D. Primary cutaneous perivascular epithelioid cell tumors: two cases and a review of the literature. Dermatol Online J 2021; 27. [PMID: 35130387 DOI: 10.5070/d3271055626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/08/2022] Open
Abstract
Report _Case Presentation _Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Primary cutaneous perivascular epithelioid cell tumors: two cases and a review of the literature Authors: Jennifer Wong1 DO, Jason Mammino2 DO, Jennifer Seyffert3 DO, Kristen Schmits4 MD, Etan Marks4 MD, Daniel Rivlin3 MD Affiliations: 1Department of Dermatology, LECOM- Larkin Community Hospital, Miami, Florida, USA, 2Department of Dermatology, KCUMB - Advanced Dermatology and Cosmetic Surgery, Orlando, Florida, USA, 3Department of Dermatology, LECOM- Skin and Cancer Associates, Miami Beach, Florida, USA, 4Department of Dermatopathology Advanced Dermatology and Cosmetic Surgery Pathology Laboratory, Delray Beach, Florida, USA Corresponding Author: Jennifer Seyffert DO, 4308 Alton Road, Suite 510, Miami Beach, FL 33140, Tel: 305-674-8865, Fax: 305-674-1459, Email: jseyf12@gmail.com Abstract: Perivascular epithelioid cell tumors, also known as PEComas, are mesenchymal neoplasms which uncommonly originate within the skin, with only 23 cases documented within the literature. These rare neoplasms classically display epithelioid cells composed of granular or clear cytoplasm arranged in sheets, nests, or cords. Their immunoreactivity for melanocytic and smooth muscle markers makes these tumors distinct and unique.[1] We herein present two cases of primary cutaneous PEComas that clinically mimic other common cutaneous neoplasms and illustrate the necessity for clinical-pathologic correlation. A literature review is also presented to compare the different clinical and histological presentations of cutaneous PEComas.
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Affiliation(s)
- Jennifer Wong
- Department of Dermatology, LECOM- Larkin Community Hospital, Miami, Florida, USA
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Affiliation(s)
- Kevin Nethers
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida
| | - Rafael E Mojica
- Edward Via College of Osteopathic Medicine, Department of Graduate Medical Education, Spartanburg, South Carolina
| | - Etan Marks
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida.,Advanced Dermatology and Cosmetic Surgery, Department of Graduate Medical Education, Maitland, Florida
| | - Robin Burger
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida.,Advanced Dermatology and Cosmetic Surgery, Department of Graduate Medical Education, Maitland, Florida
| | - Sadia Saeed
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida.,Advanced Dermatology and Cosmetic Surgery, Department of Graduate Medical Education, Maitland, Florida
| | - William Steffes
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida.,Advanced Dermatology and Cosmetic Surgery, Department of Graduate Medical Education, Maitland, Florida
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Marks E, Prystowsky MB, Fox AS. How to Succeed in Fellowship Acquisition: A Survey of Pathology Residents. Acad Pathol 2019; 6:2374289519884711. [PMID: 31799380 PMCID: PMC6859677 DOI: 10.1177/2374289519884711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/07/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022] Open
Abstract
Medical school curricula limit students’ exposure to pathology practice while pathology subspecialty training programs require residents to apply for fellowships as early as the end of their first year of training. Thus, limited exposure to pathology practice creates significant confusion and anxiety, often making the fellowship application process premature. Additionally, early focus on subspecialty training in order to acquire a fellowship adds to the initial lack of emphasis on general pathology training. We prepared a voluntary online survey with questions developed through focus groups and advice from an expert in survey design to determine which fellowships are desired and how successful residents are in their pursuit of these fellowships. The survey was distributed through the Pathology Residency Program Directors' (PRODS) listserv. Answers were solicited from pathology trainees throughout the entire training cycle. There were 141 (4.6% response rate) total respondents with each postgraduate year represented. One hundred twenty-two (95%) of 129 residents plan on completing 1 or 2 fellowships after residency training. Encouragingly, 94 (75%) of 126 pathology residents attained their desired specialty fellowship. However, 32 (32%) of 99 residents who acquired at least one fellowship chose a general surgical pathology fellowship. Furthermore, 33 (24%) respondents had already decided to pursue a specific specialty while still in medical school. An additional 32 (23%) came to their decision during postgraduate year 1. Therefore, although most residents are successful in attaining their desired fellowship, further research is needed to understand the effect of early commitment to a subspecialty and its impact on pathology education.
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Affiliation(s)
- Etan Marks
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Amy S Fox
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Marks E, Hallsworth C, McKenna L. Cognitive behavioural therapy for insomnia (CBTi) as a treatment for tinnitus-related insomnia: protocol for a randomised controlled trial. Trials 2019; 20:667. [PMID: 31791396 PMCID: PMC6889771 DOI: 10.1186/s13063-019-3778-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 10/09/2019] [Indexed: 11/29/2022] Open
Abstract
Background A significant proportion of patients with chronic tinnitus report clinical levels of sleep disturbance (insomnia). Despite the significant health and functioning implications of this, no rigorous trials have investigated treatments that target tinnitus-related insomnia. This is the first randomised controlled trial evaluating Cognitive Behavioural Therapy for insomnia (CBTi) in tinnitus compared with other psychological treatments. Methods/design The study will test the efficacy of group CBTi as a treatment for tinnitus-related insomnia in a single-centre randomised controlled trial. Participants will be 102 patients with chronic, clinically significant tinnitus and insomnia in the absence of organic sleep disorders. Participants will be randomised to one of three intervention arms: six sessions of CBTi or six sessions of sleep support group or two sessions of audiologically based care. The primary outcomes will be changes in sleep as measured on the Insomnia Severity Index and key outcomes on a 2-week sleep diary (sleep efficiency and total sleep time). Outcomes will be collected 3, 10, 14 and 34 weeks post-randomisation. Secondary measures include sleep quality, sleep beliefs, tinnitus severity, psychological distress and quality of life. A sub-sample of participants will provide two weeks of actigraphy data at the same time points. Data on satisfaction and treatment experience will be collected at 10 and 34 weeks post-randomisation from all participants. Discussion Findings from the study will be submitted to a peer-reviewed journal. It is anticipated that findings may inform future clinical practice in the treatment of tinnitus-related insomnia. Trial registration ClinicalTrials.gov, NCT03386123. Retrospectively registered on 29 December 2017.
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Affiliation(s)
- E Marks
- Department of Psychology, University of Bath, Claverton Down, Bath, BA7 2AY, UK. .,Royal National Throat Nose and Ear Hospital, 330 Gray's Inn Road, London, WC1X 8DA, UK.
| | - C Hallsworth
- Imperial College London, 535 Huxley Building, South Kensington Campus, London, UK
| | - L McKenna
- Royal National Throat Nose and Ear Hospital, 330 Gray's Inn Road, London, WC1X 8DA, UK
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Marks E, Caruso HG, Kurley SJ, Ibad S, Plasseraud KM, Monzon FA, Cockerell CJ. Establishing an evidence-based decision point for clinical use of the 31-gene expression profile test in cutaneous melanoma. ACTA ACUST UNITED AC 2019. [DOI: 10.25251/skin.3.4.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Treatment plans for cutaneous melanoma are based upon individual risk of recurrence. Decisions made post-diagnosis include recommendation for a sentinel lymph node biopsy (SLNB), followed by management decisions such as surveillance, frequency of follow-up, and interdisciplinary consultations including possible adjuvant therapy use. These have traditionally been guided by clinicopathologic factors, but discordance exists, as a substantial number of melanoma deaths occur in patients diagnosed with disease considered to be early stage by such factors, including a negative SLNB. Molecular testing can be used to apply an objective approach that optimizes individualized patient care. The 31-gene expression profile (31-GEP) test has been validated in nearly 1600 patients as an independent predictor of risk of recurrence, distant metastasis and death in Stage I-III melanoma and can guide SLNB decisions in patient subgroups, as demonstrated in 1421 patients. While clinical use of the 31-GEP test has been adopted into routine practice, an evidence-based analysis of a decision point for use in thin, T1 tumors would be clinically useful. To help define an appropriate population for 31-GEP testing, we evaluated changes in patient management, cumulative differential risk across Breslow thicknesses based on a large dataset, and 31-GEP subclass distribution in a clinically tested cohort. Based on this, appropriate use of the 31-GEP test for management decisions was found to be in cutaneous melanoma tumors ≥0.3 mm thick.
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13
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W. Mu E, Chen L, Rothman L, Rubio‐Gonzalez B, Marks E, Persad L, Cockerell CJ, Leboit P, Meehan SA. Excision recommendation rates of atypical (dysplastic) nevi amongst experienced dermatopathologists. J Cutan Pathol 2019; 46:798-799. [DOI: 10.1111/cup.13513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Euphemia W. Mu
- The Ronald O. Perelman Department of DermatologyNew York University School of Medicine New York New York
- Piedmont Plastic Surgery & Dermatology Charlotte North Carolina
| | - Lu Chen
- The Ronald O. Perelman Department of DermatologyNew York University School of Medicine New York New York
| | - Lisa Rothman
- The Ronald O. Perelman Department of DermatologyNew York University School of Medicine New York New York
| | - Belen Rubio‐Gonzalez
- Pathology DepartmentUniversity of California San Francisco San Francisco California
| | - Etan Marks
- UT Southwestern/Cockerell Dermatopathology Dallas Texas
| | - Leah Persad
- UT Southwestern/Cockerell Dermatopathology Dallas Texas
| | | | - Phil Leboit
- Pathology DepartmentUniversity of California San Francisco San Francisco California
| | - Shane A. Meehan
- The Ronald O. Perelman Department of DermatologyNew York University School of Medicine New York New York
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Al-Rohil R, Marks E, Vasudevaraja V, Kelly S, Snuderl M, Johnson DB, Jour G. c-AMP/MAPK dysregulation and its impact on survival and response to immunotherapy in advanced melanomas. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3086 Background: Immunotherapies blocking the interaction of CTLA-4 or Programmed Death 1 (PD-1) with their ligands are the standard of care for advanced MEL although many pts fail to benefit from immunotherapy. Herein, we seek to identify epigenetic and genetic signatures associated with lack of response in patients treated with immunotherapy . Methods: We performed whole exome sequencing of 580 cancer-related genes and whole-genome DNA methylation arrays targeting > 850k CpG sites covering promoters, enhancers, and transcription factor sites in 28 MEL samples from patients treated with PD-1 +/- CTLA-4 inhibitors. Findings were correlated with collected clinical history. Results: Findings are summarized in the table . Unsupervised clustering and multi-parametric analysis showed a distinct methylation signature independent of age, sex, stage, site of metastasis, or type of treatment (adj. p<0.01). Pathway analysis identified c-AMP/MAPK and PI3K-Akt signaling pathways (adj. p=2.10E-05 and 8.19E-06, respectively) enrichment in non-responders . This coincided with significant increase of mutational events in c -AMP/MAPK and PI3K-Akt pathways (p= 0.0001) including deleterious events affecting PDE4DIP (p=0.0002), a negative regulator of mTORC1, in non-responders. C-AMP/MAPK/PI3K genomic alterations were associated with a worse OS and PFS but not worse response rate (p=0.04, p=0.01, and p=0.20). PDE4DIP deleterious events were associated with decreased response rate, worse OS and PFS (p=0.002; p=0.002;p=0.00003). Conclusions: Convergent epigenetic dysregulation of cAMP/MAPK signaling and inactivation of PDE4DIP is associated with worse outcome and lack of response to immunotherapy, respectively. [Table: see text]
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Marks E. Aleukemic leukemia cutis February 2019. Cleve Clin J Med 2019; 86:302. [DOI: 10.3949/ccjm.86c.05003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Chamseddin B, Marks E, Dominguez A, Wysocki C, Vandergriff T. Refractory macrophage activation syndrome in the setting of adult-onset Still disease with hemophagocytic lymphohistiocytosis detected on skin biopsy treated with canakinumab and tacrolimus. J Cutan Pathol 2019; 46:528-531. [PMID: 30927277 DOI: 10.1111/cup.13466] [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] [Received: 12/13/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
A 19-year-old Caucasian female with adult-onset Still disease (AOSD) presented for evaluation of an acute clinical decompensation and atypical annular papules and plaques with purpura on the lower extremities. A punch biopsy demonstrated histiocytes with engulfed degenerated erythrocytes and lymphocytes, consistent with hemophagocytic lymphohistiocytosis (HLH). HLH, clinically referred to as macrophage activation syndrome, is a rare complication of AOSD and is life-threatening. Relevant clinical, laboratory, and histologic features of this diagnosis are reviewed.
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Affiliation(s)
- Bahir Chamseddin
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Etan Marks
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Arturo Dominguez
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Christian Wysocki
- Department of Allergy and Immunology, UT Southwestern Medical Center, Dallas, Texas
| | - Travis Vandergriff
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
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Abstract
Duodenal-type follicular lymphoma (D-FL) is a newly recognized entity in the 2016 World Health Organization classification update. It has an immunophenotype similar to that of other FLs and usually carries the typical t(14;18)(q32;q21) translocation. However, unlike other FLs, D-FL is almost always diagnosed at a low stage and stays localized to the small intestine, most commonly the second portion of the duodenum, whereas the vast majority of other FLs are diagnosed at an advanced stage. Additionally, D-FL gene expression and pathogenesis appear to be more closely related to extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue than to other types of FL. Therefore, many oncologists have opted to treat this variant of FL in a "watch and wait" manner because of its excellent prognosis and the rarity of D-FL to progress even when no treatments are attempted.
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Affiliation(s)
| | - Yang Shi
- From the Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Marks E, Wang Y, Shi Y, Susa J, Jacobson M, Goldstein DY. Specific TCR gene rearrangements in mycosis fungoides: does advanced clinical stage show a preference? J Clin Pathol 2018; 71:1072-1077. [PMID: 30171087 DOI: 10.1136/jclinpath-2018-205324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 11/04/2022]
Abstract
AIMS The relationship between the presence of specific T-cell receptor (TCR) gene rearrangements and clinical stage in mycosis fungoides (MF) has not been studied. We analysed a cohort of patients with a diagnosis of MF to determine the different types of specific TCR gene rearrangements present and their relationship to disease stage. METHODS A retrospective chart review was used to select patients with a diagnosis of MF who had a skin biopsy and a positive TCR gene rearrangement study in either blood or tissue and at least 2 years of clinical follow-up. RESULTS 43 patients were identified and divided into two groups. The first group consisted of 23 patients with early stage disease (IA-IIA) that was either stable or went into partial or complete remission with minimal intervention. None of these patients advanced to late stage disease. The second group consisted of 20 patients who had either late stage disease at diagnosis or progressed to late stage disease at some point in time. In the first group, only 4/23 (17%) patients had a single TCR gene rearrangement in the Vɣ1-8 region. In contrast, the second group had 13/20 (65%) patients with a single TCR gene rearrangement in the Vɣ1-8 region (p=0.002). CONCLUSION The presence of a single TCR gene rearrangement in the Vɣ1-8 region could possibly be related to a more advanced stage of MF. However, more comprehensive studies, such as next generation sequencing, with a larger cohort is necessary for a more definitive conclusion.
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Affiliation(s)
- Etan Marks
- Department of Pathology, NYU Langone Medical Center, New York, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yang Shi
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joseph Susa
- Division of Dermatopathology, Cockerell Dermatopathology, Dallas, Texas, USA
| | - Mark Jacobson
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - D Yitzchak Goldstein
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
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Marks E, Liu C, Raphael B, Arbini A. Leukemic mantle cell lymphoma and chronic lymphocytic leukemia: a rare composite lymphoma and literature review. J Hematop 2018. [DOI: 10.1007/s12308-018-0321-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Wu DW, Xia Y, Uelinger J, Forest S, Szymanski J, Mohandas K, Walsh R, Karim S, Marks E, Himchak E, Gupta R, Goldstein D. Impact of Prothrombin Complex Concentrate on Blood Use, Cost, and Outcomes in Heart Transplantation. Ann Thorac Surg 2018; 105:1152-1157. [DOI: 10.1016/j.athoracsur.2017.10.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/19/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
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21
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Ali SM, Chen D, Ali A, Krecko L, Leitzel K, Vasekar M, Nagabhairu V, Marks E, Polimera H, Richardson A, May M, He W, Patel P, Lavin M, Hofsess S, Sweetman R, Hortobagyi G, Baselga J, Lipton A. Abstract P1-07-09: Serum activin A and outcomes in HR+ /HER2- metastatic breast cancer patients treated with everolimus: Results from BOLERO-2. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-09] [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
Abstract
Background: Everolimus (EVE) plus exemestane (EXE) doubled progression-free survival (PFS) while maintaining quality of life versus EXE alone in postmenopausal women with hormone receptor positive (HR+), HER2-negative metastatic breast cancer (mBC) (BOLERO-2 phase 3; NCT00863655). Pretreatment serum activin A was previously reported as a prognostic factor in first-line hormone therapy (letrozole vs tamoxifen) (Novartis P025) and anti-HER2 mBC (lapatinib vs trastzmab) (CCTG MA.31) trials. Here we investigate the prognostic and predictive ability of activin A in BOLERO-2.
Methods: Activin A levels were determined on pretreatment serum samples using ELISA. Cox-proportional hazards model was used to assess the efficacy of EVE in the activin A low and high subgroups (median cut-point), and the prognostic effect of activin A on PFS and overall survival (OS).
Results: Baseline activin A levels were determined in 513 patients (71% of 725 BOLERO-2 patients randomized 2:1 to EVE+EXE or EXE). Predictive and prognostic signals are shown in the table below
Predictive and prognostic signalsPredictive/PrognosticEnd-pointAct-ivin ATreatmentNEventsMedian PFSHR (95% CI); p valuepredictivePFSHEXE93832.5 (1.5-2.8)-predictivePFSHEVE+EXE1631325.4 (4.1-6.8)0.46 (0.34 - 0.60); <0.0001predictivePFSLEXE89774.2 (2.0 -5.4)-predictivePFSLEVE+EXE1681059.9 (8.1-12.5)0.38 (0.28 - 0.51); <0.0001predictiveOSHEXE936820.1 (13.8-22.6)-predictiveOSHEVE+EXE16312917.7 (15.7-22.3)1.04 (0.78 - 1.40); 0.78predictiveOSLEXE8939NA (34.7-NA)-predictiveOSLEVE+EXE1687241.4 (36.4-NA)1.02 (0.69 - 1.50); 0.93prognosticPFSH 2562154.1 (2.9-4.2)-prognosticPFSL 2571826.9 (6.7-8.5)0.54 (0.45 - 0.66); <0.0001prognosticOSH 25619718.0 (16.5-21.1)-prognosticOSL 25711142.3 (38.5-NA)0.34 (0.27 - 0.42); <0.0001
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In multivariate analysis (including sensitivity to prior hormone therapy and visceral disease), activin A remained a significant independent prognostic factor for PFS and OS [HR 0.57 (0.46-0.69) and 0.34 (0.27-0.43), respectively].
Conclusions: Higher serum activin A was strongly associated with shorter PFS and OS in HR+/HER2- mBC patients. Everolimus was efficacious regardless of serum activin A level. These results are similar to our previous studies in phase 3 trials of letrozole-tamoxifen (Novartis P025), and HER2-targeted therapy, lapatinib vs trastuzmab (CCTG MA.31): pretreatment serum activin A was prognostic for outcome, but was not a predictive factor for treatment arm selection.
Citation Format: Ali SM, Chen D, Ali A, Krecko L, Leitzel K, Vasekar M, Nagabhairu V, Marks E, Polimera H, Richardson A, May M, He W, Patel P, Lavin M, Hofsess S, Sweetman R, Hortobagyi G, Baselga J, Lipton A. Serum activin A and outcomes in HR+ /HER2- metastatic breast cancer patients treated with everolimus: Results from BOLERO-2 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-09.
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Affiliation(s)
- SM Ali
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Chen
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Ali
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Krecko
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Leitzel
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Vasekar
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - V Nagabhairu
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - E Marks
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - H Polimera
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Richardson
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M May
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - W He
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - P Patel
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Lavin
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Hofsess
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Sweetman
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - G Hortobagyi
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Baselga
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Lipton
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
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Himchak E, Marks E, Shi Y, Wang Y. Did I Miss It? Discovering Hidden Coexisting Hematological Neoplasms: A Single Institutional Review of 100 Collision Tumors. Int J Surg Pathol 2018; 26:296-305. [PMID: 29320898 DOI: 10.1177/1066896917752862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A collision tumor is defined as two histologically distinct tumor types identified at the same anatomic site. Hematolymphoid proliferative disorders (HLPDs), which coincide with non-hematological neoplasms, can mimic an immune response and can easily be overlooked as an immune reaction to a solid organ neoplasm, especially when low grade. In order to avoid a delay in the diagnosis of a HLPD during the workup for a non-hematological neoplasm, we identified a cohort of 100 cases with a HLPD diagnosis during the initial workup and treatment of a non-hematological neoplasm, or vice versa. Among the 100 collision tumors, the most common non-hematological neoplasms associated with a HLPD were from the colon (17%), breast (15%), and prostate (12%). The most commonly identified HLPDs were chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; 18%), diffuse large B-cell lymphoma (17%), follicular lymphoma (14%), marginal zone lymphoma (10%), acute myeloid leukemia (8%), and classical Hodgkin lymphoma (5%). Interestingly, in this cohort 5% of the low-grade HLPDs, all of them CLL/SLL, were missed at initial sign-out and subsequently required an addendum report. The other 95% of cases were reviewed or signed out by a hematopathologist before the report was finalized for the non-hematological neoplasm. In summary, high-grade hematological malignancies are less likely to be missed; however, low-grade coexisting HLPDs can be overlooked as a reactive immune response to a solid organ neoplasm. Therefore, it is important to keep in mind the existence of collision low-grade HLPDs before assuming the lymphoid infiltrates as an immunological response.
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Affiliation(s)
- Evan Himchak
- 1 Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Etan Marks
- 1 Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yang Shi
- 1 Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yanhua Wang
- 1 Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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23
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Marks E, Naudin C, Nolan G, Goggins BJ, Burns G, Mateer SW, Latimore JK, Minahan K, Plank M, Foster PS, Callister R, Veysey M, Walker MM, Talley NJ, Radford-Smith G, Keely S. Regulation of IL-12p40 by HIF controls Th1/Th17 responses to prevent mucosal inflammation. Mucosal Immunol 2017; 10:1224-1236. [PMID: 28120851 DOI: 10.1038/mi.2016.135] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 12/06/2016] [Indexed: 02/04/2023]
Abstract
Intestinal inflammatory lesions are inherently hypoxic, due to increased metabolic demands created by cellular infiltration and proliferation, and reduced oxygen supply due to vascular damage. Hypoxia stabilizes the transcription factor hypoxia-inducible factor-1α (HIF) leading to a coordinated induction of endogenously protective pathways. We identified IL12B as a HIF-regulated gene and aimed to define how the HIF-IL-12p40 axis influenced intestinal inflammation. Intestinal lamina propria lymphocytes (LPL) were characterized in wild-type and IL-12p40-/- murine colitis treated with vehicle or HIF-stabilizing prolyl-hydroxylase inhibitors (PHDi). IL12B promoter analysis was performed to examine hypoxia-responsive elements. Immunoblot analysis of murine and human LPL supernatants was performed to characterize the HIF/IL-12p40 signaling axis. We observed selective induction of IL-12p40 following PHDi-treatment, concurrent with suppression of Th1 and Th17 responses in murine colitis models. In the absence of IL-12p40, PHDi-treatment was ineffective. Analysis of the IL12B promoter identified canonical HIF-binding sites. HIF stabilization in LPLs resulted in production of IL-12p40 homodimer which was protective against colitis. The selective induction of IL-12p40 by HIF-1α leads to a suppression of mucosal Th1 and Th17 responses. This HIF-IL12p40 axis may represent an endogenously protective mechanism to limit the progression of chronic inflammation, shifting from pro-inflammatory IL-12p70 to an antagonistic IL-12p40 homodimer.
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Affiliation(s)
- E Marks
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - C Naudin
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - G Nolan
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - B J Goggins
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia
| | - G Burns
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia
| | - S W Mateer
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia
| | - J K Latimore
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia
| | - K Minahan
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia
| | - M Plank
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - P S Foster
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - R Callister
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia
| | - M Veysey
- Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia.,School of Medicine, Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - M M Walker
- Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia.,School of Medicine, Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - N J Talley
- Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia.,School of Medicine, Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - G Radford-Smith
- Royal Brisbane and Women's Hospital, Brisbane, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - S Keely
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, New South Wales, Australia
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Marks E, Shi Y, Wang Y. CD117 (KIT) is a useful marker in the diagnosis of plasmablastic plasma cell myeloma. Histopathology 2017; 71:81-88. [DOI: 10.1111/his.13196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/19/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Etan Marks
- Department of Pathology; Montefiore Medical Center/Albert Einstein College of Medicine; Bronx NY USA
| | - Yang Shi
- Department of Pathology; Montefiore Medical Center/Albert Einstein College of Medicine; Bronx NY USA
| | - Yanhua Wang
- Department of Pathology; Montefiore Medical Center/Albert Einstein College of Medicine; Bronx NY USA
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25
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Abstract
Infantile digital fibroma is a rare benign lesion that usually occurs during the first 2 years of life. It can be multiple, but it is usually a single lesion. If it grows large enough it can cause joint deformities or interfere with everyday activities. Microscopically, the neoplastic cells usually have inclusion bodies that are best highlighted with a Masson trichrome stain but can often be seen on hematoxylin-eosin staining. Treatment for this entity is usually watchful waiting because of its ability to spontaneously regress, but excision is recommended if the lesion is symptomatic. More recently, fluorouracil or injectable steroids have shown great promise in inducing regression without the complications that accompany surgery.
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Affiliation(s)
- Etan Marks
- From the Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Marks E, Amin SM, Xia L, Guitart J, Laskin W. Pseudoangiomatous Spindle Cell Lipoma: a distinct subtype of spindle cell lipoma. Pathol Int 2016; 67:176-178. [PMID: 27982506 DOI: 10.1111/pin.12497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/28/2016] [Accepted: 12/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Etan Marks
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Sapna M Amin
- Division of Dermatopathology, Department of Dermatology, Northwestern University, Chicago, IL
| | - Ling Xia
- Division of Dermatopathology, Forefront Dermatology, Milwaukee, WI
| | - Joan Guitart
- Division of Dermatopathology, Department of Dermatology, Northwestern University, Chicago, IL
| | - William Laskin
- Department of Pathology, Bridgeport Hospital, Yale New Haven Health, New Haven, CT
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Goldstein D, Uehlinger J, Szymanski J, Mohandas K, Walsh R, Karim S, Marks E, Himchak E, Gupta R, Wu D. Use of Four-Factor Prothrombin Concentrate Complex in LVAD Recipients Undergoing Transplantation: Impact on Blood Loss, Blood Use, Blood Bank Costs and Clinical Outcomes. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Marks E, Dorokhova O, Amin B, Jacobson M. Eruptive angiokeratomas and porokeratosis in the setting of sclerodermatous graft-vs.-host disease. J Cutan Pathol 2016; 43:516-519. [PMID: 26957361 DOI: 10.1111/cup.12685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 11/27/2022]
Abstract
Porokeratosis and angiokeratomas are both seen in the setting of chronic graft-vs.-host disease (GVHD), but rarely occur together. We present a case of a patient with lichen planus-like (LPL) and sclerodermatous chronic GVHD manifesting after allogeneic bone marrow transplant with concomitant eruptive angiokeratomas and porokeratosis.
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Affiliation(s)
- Etan Marks
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Olena Dorokhova
- Division of Pathology, Fairfield County Pathology Consultants, LLC, Bridgeport, CT, USA
| | - Bijal Amin
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mark Jacobson
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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29
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Marks E, Mayer E, Szymczak W, Munjal I. Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry Used to Correctly Identify Kingella kingae Endocarditis. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Alhabbab R, Blair P, Elgueta R, Stolarczyk E, Marks E, Becker PD, Ratnasothy K, Smyth L, Safinia N, Sharif-Paghaleh E, O’Connell S, Noelle RJ, Lord GM, Howard JK, Spencer J, Lechler RI, Lombardi G. Diversity of gut microflora is required for the generation of B cell with regulatory properties in a skin graft model. Sci Rep 2015; 5:11554. [PMID: 26109230 PMCID: PMC4479822 DOI: 10.1038/srep11554] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 10/28/2014] [Accepted: 05/22/2015] [Indexed: 11/09/2022] Open
Abstract
B cells have been reported to promote graft rejection through alloantibody production. However, there is growing evidence that B cells can contribute to the maintenance of tolerance. Here, we used a mouse model of MHC-class I mismatched skin transplantation to investigate the contribution of B cells to graft survival. We demonstrate that adoptive transfer of B cells prolongs skin graft survival but only when the B cells were isolated from mice housed in low sterility "conventional" (CV) facilities and not from mice housed in pathogen free facilities (SPF). However, prolongation of skin graft survival was lost when B cells were isolated from IL-10 deficient mice housed in CV facilities. The suppressive function of B cells isolated from mice housed in CV facilities correlated with an anti-inflammatory environment and with the presence of a different gut microflora compared to mice maintained in SPF facilities. Treatment of mice in the CV facility with antibiotics abrogated the regulatory capacity of B cells. Finally, we identified transitional B cells isolated from CV facilities as possessing the regulatory function. These findings demonstrate that B cells, and in particular transitional B cells, can promote prolongation of graft survival, a function dependent on licensing by gut microflora.
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Affiliation(s)
- R. Alhabbab
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - P. Blair
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - R. Elgueta
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - E. Stolarczyk
- Division of Diabetes and Nutritional Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - E. Marks
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - P. D. Becker
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - K. Ratnasothy
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - L. Smyth
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - N. Safinia
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - E. Sharif-Paghaleh
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - S. O’Connell
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - R. J. Noelle
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - G. M. Lord
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - J. K. Howard
- Division of Diabetes and Nutritional Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - J. Spencer
- Peter Gorer Department of Immunobiology, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - R. I. Lechler
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
| | - G. Lombardi
- Medical Research Council Centre for Transplantation, King’s College London, King’s Health Partners, Guy’s Hospital, London SE1 9RT, UK
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31
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Zhao S, Gardner K, Taylor W, Marks E, Goodson N. OP0015 Changing Patterns of Requests for Measurement of Vitamin D in Primary Care: an Observational Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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32
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Abstract
Non-cardiac chest pain is common. It has a low risk of coronary events, but causes considerable physical and social disability and inappropriate health-care usage. It is a heterogeneous condition, which may be caused by or associated with gastro-oesophageal, musculoskeletal or psychiatric abnormalities and sustained by psychological factors including catastrophisation, avoidance behaviour and abnormal help-seeking. These may coexist and their relative contributions may vary in different patients or at different times in an individual patient. The absence of a unitary cause probably explains why treatment studies show only moderate success. An individualised biopsychosocial approach takes account of all causative and sustaining processes and has been shown to work in pain syndromes at other sites. We suggest that this approach should be tried for chest pain using a multidisciplinary clinic model including cardiologists, psychologists and nurses linked with a Rapid Access Chest Pain Clinic.
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Affiliation(s)
- J B Chambers
- Cardiothoracic Centre and Department of Psychological Medicine, Guy's and St Thomas' Hospitals, London, UK.
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Hannan FM, Nesbit MA, Zhang C, Cranston T, Curley AJ, Harding B, Fratter C, Rust N, Christie PT, Turner JJO, Lemos MC, Bowl MR, Bouillon R, Brain C, Bridges N, Burren C, Connell JM, Jung H, Marks E, McCredie D, Mughal Z, Rodda C, Tollefsen S, Brown EM, Yang JJ, Thakker RV. Identification of 70 calcium-sensing receptor mutations in hyper- and hypo-calcaemic patients: evidence for clustering of extracellular domain mutations at calcium-binding sites. Hum Mol Genet 2012; 21:2768-78. [DOI: 10.1093/hmg/dds105] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [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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34
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Cox J, Graves L, Marks E, Tremblay C, Stephenson R, Lambert-Lanning A, Steben M. Knowledge, attitudes and behaviours associated with the provision of hepatitis C care by Canadian family physicians. J Viral Hepat 2011; 18:e332-40. [PMID: 21692945 DOI: 10.1111/j.1365-2893.2010.01426.x] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The role of primary care physicians in providing care for hepatitis C virus (HCV) infection is increasingly emphasized, but many gaps and challenges remain. This study explores family physicians' knowledge, attitudes and practices associated with providing care for HCV infection. Seven hundred and forty-nine members of the College of Family Physicians of Canada (CFPC) completed a self-administered survey examining knowledge, attitudes and behaviours regarding HCV infection screening and care. Multivariate analyses were performed using the outcome, HCV care provision, and variables based on a conceptual model of practice guideline adherence. Family physicians providing basic-advanced HCV care were more likely to be older, practice in a rural setting, have injection drug users (IDU) in their practice and have higher levels of knowledge about the initial assessment (OR = 1.77; 95% CI = 1.23-2.54) and treatment of HCV (OR = 1.74; 95% CI = 1.24-2.43). They were also less likely to believe that family physicians do not have a role in HCV care (OR = 0.41; 95% CI = 0.30-0.58). Educational programmes should target physicians less likely to provide HCV care, namely family physicians practicing in urban areas and those who do not care for any IDU patients. Training and continuing medical education programmes that aim to shift family physicians' attitudes about the provision of HCV care by promoting their roles as integral to HCV care could contribute to easing the burden on consultant physicians and lead to improved access to treatment for HCV infection.
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Affiliation(s)
- J Cox
- McGill University, Montreal, QC, Canada.
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35
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Foster KA, Adams EJ, Durose L, Cruttwell CJ, Marks E, Shone CC, Chaddock JA, Cox CL, Heaton C, Sutton JM, Wayne J, Alexander FCG, Rogers DF. Re-engineering the target specificity of Clostridial neurotoxins - a route to novel therapeutics. Neurotox Res 2006; 9:101-7. [PMID: 16785105 DOI: 10.1007/bf03354881] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The ability to chemically couple proteins to LH(N)-fragments of clostridial neurotoxins and create novel molecules with selectivity for cells other than the natural target cell of the native neurotoxin is well established. Such molecules are able to inhibit exocytosis in the target cell and have the potential to be therapeutically beneficial where secretion from a particular cell plays a causative role in a disease or medical condition. To date, these molecules have been produced by chemical coupling of the LH(N)-fragment and the targeting ligand. This is, however, not a suitable basis for producing pharmaceutical agents as the products are ill defined, difficult to control and heterogeneous. Also, the molecules described to date have targeted neuroendocrine cells that are susceptible to native neurotoxins, and therefore the benefit of creating a molecule with a novel targeting domain has been limited. In this paper, the production of a fully recombinant fusion protein from a recombinant gene encoding both the LH(N)-domain of a clostridial neurotoxin and a specific targeting domain is described, together with the ability of such recombinant fusion proteins to inhibit secretion from non-neuronal target cells. Specifically, a novel protein consisting of the LH(N)-domains of botulinum neurotoxin type C and epidermal growth factor (EGF) that is able to inhibit secretion of mucus from epithelial cells is reported. Such a molecule has the potential to prevent mucus hypersecretion in asthma and chronic obstructive pulmonary disease.
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Affiliation(s)
- K A Foster
- Health Protection Agency, Centre for Emergency Preparedness & Response, Porton Down, Salisbury, UK.
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36
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Brothers C, Marks E, Smolowitz R. Conditions affecting the growth and zoosporulation of the prostitan parasite QPX in culture. Biol Bull 2000; 199:200-201. [PMID: 11081735 DOI: 10.2307/1542897] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- C Brothers
- Falmouth High School, Massachusetts 02540, USA
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37
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Spang L, Marks E, Adams N. Health Sciences Information Tools 2000: a cooperative health sciences library/public school information literacy program for medical assistant students. Bull Med Libr Assoc 1998; 86:534-40. [PMID: 9803297 PMCID: PMC226447] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Educating diverse groups in how to access, use, and evaluate information available through information technologies is emerging as an essential responsibility for health sciences librarians in today's complex health care system. One group requiring immediate attention is medical assistants. Projections indicate that medical assistant careers will be among the fastest growing occupations in the twenty-first century. The expanding use and importance of information in all health care settings requires that this workforce be well versed in information literacy skills. But, for public school vocational education staff charged with educating entry level workers to meet this specialized demand, the expense of hiring qualified professionals and acquiring the sophisticated technology necessary to teach such skills poses a dilemma. Health Sciences Information Tools 2000, a cooperative work-study information literacy program jointly formulated by the Wayne State University's Shiffman Medical Library and the Detroit Public Schools' Crockett Career and Technical Center, demonstrates that cooperation between the health sciences library and the public school is a mutually beneficial and constructive solution. This article describes the background, goals, curriculum, personnel, costs, and evaluation methods of Tools 2000. The Shiffman-Crockett information literacy program, adaptable to a variety of library settings, is an innovative means of preparing well-trained high school vocational education students for beginning level medical assistant positions as well as further education in the health care field.
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Affiliation(s)
- L Spang
- Wayne State University, Detroit, Michigan 48201, USA
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38
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Marks E. Attitudes of the elderly towards their own oral health and dentistry. Aust Dent J 1994; 39:329. [PMID: 7811215 DOI: 10.1111/j.1834-7819.1994.tb05577.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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39
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Rouan G, Marks E, Tuchfarber B, Redington TJ, Lorenzi N. Development, effects, and educational outcomes of reporting from a clinical database. Med Decis Making 1991; 11:S80-9. [PMID: 1663196] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To develop clinically applicable and educationally useful reports from a clinical database, the authors explored the development of such databases at a medical center. The patient-centered database (PCD) integrates disparate data resources in the service of academic clinicians, postgraduate trainees, and students. From the PCD, daily and monthly reports are generated, which include 1) census update reports, serving as an educational format for a daily case-based morning report discussion and routine rounds; 2) reports of daily admissions and patient census stratified by appropriate housestaff providing the clinical care; and 3) quality assurance measures such as monitoring of length of stay of each patient regardless of the initial housestaff service to which the patient is initially admitted. The results of expanding the number of report beneficiaries, outcomes from a five-month test period, and possibilities for further development and implementation are considered.
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Affiliation(s)
- G Rouan
- University of Cincinnati, College of Medicine, Department of Internal Medicine, OH
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40
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Hoffman A, Grossman E, Ohman KP, Marks E, Keiser HR. The initial vasodilation and the later vasoconstriction of endothelin-1 are selective to specific vascular beds. Am J Hypertens 1990; 3:789-91. [PMID: 2222944 DOI: 10.1093/ajh/3.10.789] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The regional hemodynamic effects of endothelin-1 (ET-1) were studied in Wistar-Kyoto rats. Endothelin-1 caused a transient increase in blood flow in the carotid and femoral arteries but a decrease in flow in the renal and mesenteric arteries. The resistance in the carotid and femoral beds decreased while it increased in the renal and mesenteric beds. Subsequently there was a variable increase in resistance in all vascular beds with a maximal increase in the renal bed. Thus, ET-1 initially causes a selective vasorelaxation in musculocutaneous beds but not in visceral beds; the cause of this selectivity is unknown.
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Affiliation(s)
- A Hoffman
- Hypertension-Endocrine Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892
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41
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Hoffman A, Grossman E, Ohman KP, Marks E, Keiser HR. Endothelin induces an initial increase in cardiac output associated with selective vasodilation in rats. Life Sci 1989; 45:249-55. [PMID: 2668674 DOI: 10.1016/0024-3205(89)90257-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The systemic and regional hemodynamic effects of endothelin (ET), a novel endothelial derived vasoconstrictor peptide were studied in Wistar Kyoto rats. A bolus of 1 nmol/Kg ET intravenously induced a transient 43% decrease in blood pressure associated with a 57% decrease in systemic resistance and a 30% increase in cardiac output (p less than 0.01 for all parameters). This was followed by an increase of 20% in arterial pressure and of 71% in systemic resistance and a decrease of 30% in cardiac output at 10 minutes. The initial fall in blood pressure was not abolished by pretreatment with verapamil, captopril, indomethacin, ketanserin, atropine, methylene blue or ethanol. Verapamil abolished the hypertensive phase by markedly decreasing cardiac output. ET had selective effects on the arterial tree; during the hypotensive phase it caused a transient increase in blood flow in the carotid and femoral arteries (+41% and +83% respectively, p less than 0.01) but a decrease in flow in the renal and mesenteric arteries (-53% and -44% respectively, p less than 0.05). Accordingly, there was a decrease in resistance in the carotid and femoral beds (-55% and -67% respectively, p less than 0.01) and an increase in resistance in the renal and mesenteric beds (+102%; p less than 0.01 and +23%; p = N.S. respectively). Subsequently there was an increase in resistance in all vascular beds to variable degrees. The maximal increase in resistance was in the renal bed (+156%). Thus, ET causes initially a potent systemic vasorelaxation and an increase in cardiac output later progressing to systemic vasoconstriction and a decrease in cardiac output. The initial vasodilation is selective, appearing in musculocutaneous beds but not in visceral beds.
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Affiliation(s)
- A Hoffman
- Hypertension-Endocrine Branch, National Heart, Lung and Blood Institute, NIH, Bethesda MD
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42
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Andrykowski MA, Jacobsen PB, Marks E, Gorfinkle K, Hakes TB, Kaufman RJ, Currie VE, Holland JC, Redd WH. Prevalence, predictors, and course of anticipatory nausea in women receiving adjuvant chemotherapy for breast cancer. Cancer 1988; 62:2607-13. [PMID: 3191461 DOI: 10.1002/1097-0142(19881215)62:12<2607::aid-cncr2820621226>3.0.co;2-s] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Factors related to the prevalence, prediction, and course of anticipatory nausea (AN) in women (n = 77) receiving adjuvant chemotherapy for breast cancer were examined. Using a prospective longitudinal research design, patients were interviewed both before and after each chemotherapy infusion. Fifty-seven percent of the patients developed AN. These patients were characterized by more severe gastrointestinal side effects following the initial infusion and greater expectations for experiencing chemotherapy-related nausea. A more rapid development of AN was related to a history of experiencing nausea across a greater variety of situations, higher IV drug doses, and less infusion-related anxiety at the initial infusion. Although AN occurred intermittently across treatment sessions, severity was constant. Results provided strong support for the hypothesis that classical conditioning processes are instrumental in AN acquisition. The role of anxiety in the development of AN is considered as are clinical implications for the prevention of AN and recommendations for future research.
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Affiliation(s)
- M A Andrykowski
- Psychiatry Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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43
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Marks E, Miszczak J. [Chronoelectroencephalography in the diagnosis of neurologic diseases]. Neurol Neurochir Pol 1985; 19:427-31. [PMID: 3913871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Marks E. Names for PEG-electrolyte lavage solutions. Am J Hosp Pharm 1985; 42:1710. [PMID: 4036966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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45
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White SL, Marks E. Delineating management authority in community mental health centers. J Ment Health Adm 1985; 11:41-3. [PMID: 10269108 DOI: 10.1007/bf02829029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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46
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Marks E. [Case of Parsonage-Turner syndrome]. Wiad Lek 1984; 37:1125-6. [PMID: 6516368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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47
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Marks E, Dworecki J. [Treatment of sciatica by acupuncture]. Wiad Lek 1983; 36:1061-5. [PMID: 6356623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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48
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Marks E. [Case of amnestic stroke]. Wiad Lek 1983; 36:939-40. [PMID: 6624106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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49
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Zuzewicz W, Marks E. [Rare case of ophthalmoplegic migraine]. Wiad Lek 1983; 36:399-400. [PMID: 6868594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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50
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Zuzewicz W, Marks E. [Recurrent abducens nerve damage after epidural anesthesia]. Wiad Lek 1982; 35:1563-5. [PMID: 7168169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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