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Hwang CK, Matta R, Woolstenhulme J, Britt AK, Schaeffer AJ, Zakaluzny SA, Kleber KT, Sheikali A, Flynn-O'Brien KT, Sandilos G, Shimonovich S, Fox N, Hess AB, Zeller KA, Koberlein GC, Levy BE, Draus JM, Sacks M, Chen C, Luo-Owen X, Stephens JR, Shah M, Burks F, Moses RA, Rezaee ME, Vemulakonda VM, Halstead NV, LaCouture HM, Nabavizadeh B, Copp H, Breyer B, Schwartz I, Feia K, Pagliara T, Shi J, Neuville P, Hagedorn JC. Management of pediatric renal trauma: Results from the American Association for Surgery and Trauma Multi-Institutional Pediatric Acute Renal Trauma Study. J Trauma Acute Care Surg 2024; 96:805-812. [PMID: 37966460 DOI: 10.1097/ta.0000000000004198] [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: 11/16/2023]
Abstract
BACKGROUND Pediatric renal trauma is rare and lacks sufficient population-specific data to generate evidence-based management guidelines. A nonoperative approach is preferred and has been shown to be safe. However, bleeding risk assessment and management of collecting system injury are not well understood. We introduce the Multi-institutional Pediatric Acute Renal Trauma Study (Mi-PARTS), a retrospective cohort study designed to address these questions. This article describes the demographics and contemporary management of pediatric renal trauma at Level I trauma centers in the United States. METHODS Retrospective data were collected at 13 participating Level I trauma centers on pediatric patients presenting with renal trauma between 2010 and 2019. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Descriptive statistics were used to report on demographics, acute management, and outcomes. RESULTS In total, 1,216 cases were included in this study. Of all patients, 67.2% were male, and 93.8% had a blunt injury mechanism. In addition, 29.3% had isolated renal injuries, and 65.6% were high-grade (American Association for the Surgery of Trauma Grades III-V) injuries. The mean Injury Severity Score was 20.5. Most patients were managed nonoperatively (86.4%), and 3.9% had an open surgical intervention, including 2.7% having nephrectomy. Angioembolization was performed in 0.9%. Collecting system intervention was performed in 7.9%. Overall mortality was 3.3% and was only observed in patients with multiple injuries. The rate of avoidable transfer was 28.2%. CONCLUSION The management and outcomes of pediatric renal trauma lack data to inform evidence-based guidelines. Nonoperative management of bleeding following renal injury is a well-established practice. Intervention for renal trauma is rare. Our findings reinforce differences from the adult population and highlights opportunities for further investigation. With data made available through Mi-PARTS, we aimed to answer pediatric specific questions, including a pediatric-specific bleeding risk nomogram, and better understanding indications for interventions for collecting system injuries. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Catalina K Hwang
- From the Department of Urology (C.K.H.), University of Washington, Seattle, Washington; Division of Urology, Department of Surgery (R.M.), School of Medicine (J.W.), and Division of Urology, Department of Surgery (R.M., J.W., A.K.B., A.J.S.), Intermountain Primary Children's Hospital, University of Utah, Salt Lake City, Utah; Department of Surgery (S.A.Z., K.T.K.), University of California Davis, Sacramento, California; Medical College of Wisconsin, School of Medicine (A.S.); Department of Surgery (K.T.F.-O'.B.), Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin; Division of Trauma, Department of General Surgery (G.S., S.S., N.F.), Cooper University Health Care, Camden, New Jersey; Department of Surgery (A.B.H.), WakeMed, Raleigh; Department of General Surgery (K.A.Z.), Section of Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Radiology (G.C.K.), Nemours Children's Hospital, Orlando, Florida; Division of Pediatric Surgery, Department of Surgery (B.E.L.), University of Kentucky, Lexington, Kentucky; Nemours Children's Health (J.M.D.), Jacksonville, Florida; Department of Surgery (M.S.), Department of Urology (C.C.), and Department of Surgery (X.L.-O.), Loma Linda University Medical Center and Children's Hospital, Loma Linda, California; Department of Urology (J.R.S., M.S., F.B.), Beaumont Health-Royal Oak, Royal Oak, Michigan; Department of Surgery (R.A.M., M.E.R.), Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Pediatric Urology Research Enterprise, Department of Pediatric Urology (V.M.V., N.V.H., H.M.L.), Children's Hospital Colorado; Division of Urology, Department of Surgery (V.M.V., N.V.H., H.M.L.), University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado; Department of Urology (B.N.), Cornell University; Department of Urology (H.C., B.B.), University of California San Francisco, San Francisco, California; Division of Urology (I.S., K.F., T.P.), Hennepin Healthcare, Minneapolis, Minnesota; Harborview Injury Prevention and Research Center (J.S.); and Department of Urology (P.N., J.C.H.), University of Washington, Seattle, Washington
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Matta R, Keihani S, Hebert K, Horns JJ, Nirula R, McCrum M, McCormick BJ, Gross JA, Joyce RP, Rogers DM, Wang SS, Hagedorn JC, Selph JP, Sensenig RL, Moses RA, Dodgion CM, Gupta S, Mukherjee K, Majercik S, Broghammer JA, Schwartz I, Elliott SP, Breyer BN, Baradaran N, Zakaluzny S, Erickson BA, Miller BD, Askari R, Carrick MM, Burks FN, Norwood S, Myers JB. PROPOSED REVISION OF THE AMERICAN ASSOCIATION FOR SURGERY OF TRAUMA RENAL TRAUMA ORGAN INJURY SCALE: SECONDARY ANALYSIS OF THE MULTI-INSTITUTIONAL GENITOURINARY TRAUMA STUDY. J Trauma Acute Care Surg 2024:01586154-990000000-00628. [PMID: 38319246 DOI: 10.1097/ta.0000000000004232] [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: 02/07/2024]
Abstract
BACKGROUND This study updates the American Association for Surgery of Trauma (AAST) Organ Injury Scale (OIS) for renal trauma using evidence-based criteria for bleeding control intervention. METHODS This was a secondary analysis of a multi-center retrospective study including patients with high grade renal trauma from 7 Level-1 trauma centers from 2013-2018. All eligible patients were assigned new renal trauma grades based on revised criteria. The primary outcome used to measure injury severity was intervention for renal bleeding. Secondary outcomes included intervention for urinary extravasation, units of packed red blood cells (PRBCs) transfused within 24 hours, and mortality. To test the revised grading system, we performed mixed effect logistic regression adjusted for multiple baseline demographic and trauma covariates. We determined the area under the receiver-operator curve (AUC) to assess accuracy of predicting bleeding interventions from the revised grading system and compared this to 2018 AAST organ injury scale. RESULTS based on the 2018 OIS grading system, we included 549 patients with AAST Grade III-V injuries and CT scans (III: 52% (n = 284), IV: 45% (n = 249), and V: 3% (n = 16)). Among these patients, 89% experienced blunt injury (n = 491) and 12% (n = 64) underwent intervention for bleeding. After applying the revised grading criteria, 60% (n = 329) of patients were downgraded and 4% (n = 23) were upgraded; 2.8% (n = 7) downgraded from grade V to IV, and 69.5% (n = 173) downgraded from IV to III. The revised renal trauma grading system demonstrated improved predictive ability for bleeding interventions (2018 AUC = 0.805, revised AUC = 0.883; p = 0.001) and number of units of PRBCs transfused. When we removed urinary injury from the revised system, there was no difference in its predictive ability for renal hemorrhage intervention. CONCLUSIONS A revised renal trauma grading system better delineates the need for hemostatic interventions than the current AAST OIS renal trauma grading system. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rano Matta
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sorena Keihani
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kevin Hebert
- Department of Surgery, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Joshua J Horns
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Raminder Nirula
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Marta McCrum
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Ryan P Joyce
- NYU Grossman School of Medicine, New York, NY, USA
| | - Douglas M Rogers
- Department of Radiology, University of Utah Salt Lake City, UT, USA
| | | | - Judith C Hagedorn
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, Washington
| | - J Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel L Sensenig
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Shubham Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA
| | | | - Ian Schwartz
- Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin N Breyer
- Department of Urology, University of California - San Francisco, San Francisco, CA, USA
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Scott Zakaluzny
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Brandi D Miller
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | - Reza Askari
- Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Scott Norwood
- Department of Surgery, UT Health Tyler, Tyler, TX, USA
| | - Jeremy B Myers
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
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Keihani S, Rogers DM, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Majercik S, Sensenig RL, Schwartz I, Erickson BA, Moses RA, Selph JP, Norwood S, Smith BP, Dodgion CM, Mukherjee K, Breyer BN, Baradaran N, Myers JB. Shattered Kidney After Renal Trauma: Should It Be Classified As an American Association for the Surgery of Trauma Grade V Injury? Urology 2023; 179:181-187. [PMID: 37356461 DOI: 10.1016/j.urology.2023.06.015] [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] [Received: 04/15/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To study the prevalence and management of shattered kidney and to evaluate if the new description of "loss of identifiable renal anatomy" in the 2018 American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) would improve the ability to predict bleeding control interventions. METHODS We used high-grade renal trauma data from 21 Level-1 trauma centers from 2013 to 2018. Initial CT scans were reviewed to identify shattered kidneys, defined as a kidney having ≥3 parenchymal fragments displaced by blood or fluid on cross-sectional imaging. We further categorized patients with shattered kidney in two models based on loss of identifiable renal parenchymal anatomy and presence or absence of vascular contrast extravasation (VCE). Bleeding interventions were compared between the groups. RESULTS From 861 high-grade renal trauma patients, 41 (4.8%) had shattered kidney injury. 25 (61%) underwent a bleeding control intervention including 18 (43.9%) nephrectomies and 11 (26.8%) angioembolizations. 18 (41%) had shattered kidney with "loss of identifiable parenchymal renal anatomy" per 2018 AAST OIS (model-1). 28 (68.3%) had concurrent VCE (model-2). Model-2 had a statistically significant improvement in area under the curve over model-1 in predicting bleeding interventions (0.75 vs 0.72; P = .01). CONCLUSION Shattered kidney is associated with high rates of active bleeding, urinary extravasation, and interventions including nephrectomy. The definition of shattered kidney is vague and subjective and our definition might be simpler and more reproducible. Loss of identifiable renal anatomy per the 2018 AAST OIS did not provide better distinction for bleeding control interventions over presence of VCE.
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Affiliation(s)
- Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
| | | | | | - Joel A Gross
- Department of Radiology, University of Washington, Seattle, WA
| | - Ryan P Joyce
- Department of Radiology, University of Washington, Seattle, WA
| | | | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - Rachel L Sensenig
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ
| | - Ian Schwartz
- Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | | | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | | | - Brian P Smith
- Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Benjamin N Breyer
- Department of Urology, University of California - San Francisco, San Francisco, CA
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
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Hakam N, Keihani S, Shaw NM, Abbasi B, Jones CP, Rogers D, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Selph JP, Sensenig RL, Moses RA, Dodgion CM, Gupta S, Mukherjee K, Majercik S, Smith BP, Broghammer JA, Schwartz I, Baradaran N, Zakaluzny SA, Erickson BA, Miller BD, Askari R, Carrick MM, Burks FN, Norwood S, Myers JB, Breyer BN. Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study. World J Urol 2023; 41:1983-1989. [PMID: 37356027 DOI: 10.1007/s00345-023-04432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/09/2023] [Indexed: 06/27/2023] Open
Abstract
PURPOSE To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management. METHODS We used prospectively collected data as part of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We included patients with grade V renal trauma according to the AAST Injury Scoring Scale 2018 update. All cases submitted by participating centers with radiology images available were independently reviewed to confirm renal trauma grade. Management was classified as expectant, conservative (minimally invasive, endoscopic or percutaneous procedures), or operative (renal-related surgery). RESULTS Eighty patients were included, 25 of whom had complete imaging and had independent confirmation of AAST grade V renal trauma. Median age was 35 years (Interquartile range (IQR) 25-50) and 23 (92%) had blunt trauma. Ten patients (40%) were managed operatively with nephrectomy. Conservative management was used in nine patients (36%) of which six received angioembolization and three had a stent or drainage tube placed. Expectant management was followed in six (24%) patients. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size and laceration size. Vascular contrast extravasation was more likely in operatively managed patients though a statistically significant association was not found. CONCLUSION Successful use of nonoperative management for grade V injuries is used for a substantial subset of patients. Lower transfusion requirement and less severe injury radiologic phenotype appear to be important characteristics delineating this group.
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Affiliation(s)
- Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Nathan M Shaw
- Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Charles P Jones
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Douglas Rogers
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Sherry S Wang
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Ryan P Joyce
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Judith C Hagedorn
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - J Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel L Sensenig
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Shubham Gupta
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA
| | - Brian P Smith
- Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ian Schwartz
- Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Nima Baradaran
- Department of Urology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Scott A Zakaluzny
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Brandi D Miller
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | - Reza Askari
- Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Scott Norwood
- Department of Surgery, UT Health Tyler, Tyler, TX, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
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Cordova JC, Sun S, Bos J, Thirumalairajan S, Ghone S, Hirai M, Busse RA, der Hardt JSV, Schwartz I, Zhou J. Development of a Single-Step Antibody-Drug Conjugate Purification Process with Membrane Chromatography. J Clin Med 2021; 10:jcm10030552. [PMID: 33540865 PMCID: PMC7867349 DOI: 10.3390/jcm10030552] [Citation(s) in RCA: 3] [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: 12/31/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 01/07/2023] Open
Abstract
Membrane chromatography is routinely used to remove host cell proteins, viral particles, and aggregates during antibody downstream processing. The application of membrane chromatography to the field of antibody-drug conjugates (ADCs) has been applied in a limited capacity and in only specialized scenarios. Here, we utilized the characteristics of the membrane adsorbers, Sartobind® S and Phenyl, for aggregate and payload clearance while polishing the ADC in a single chromatographic run. The Sartobind® S membrane was used in the removal of excess payload, while the Sartobind® Phenyl was used to polish the ADC by clearance of unwanted drug-to-antibody ratio (DAR) species and aggregates. The Sartobind® S membrane reproducibly achieved log-fold clearance of free payload with a 10 membrane-volume wash. Application of the Sartobind® Phenyl decreased aggregates and higher DAR species while increasing DAR homogeneity. The Sartobind® S and Phenyl membranes were placed in tandem to simplify the process in a single chromatographic run. With the optimized binding, washing, and elution conditions, the tandem membrane approach was performed in a shorter timescale with minimum solvent consumption and high yield. The application of the tandem membrane chromatography system presents a novel and efficient purification scheme that can be realized during ADC manufacturing.
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Affiliation(s)
- Juan Carlos Cordova
- Abzena, 360 George Patterson Boulevard, Bristol, PA 19007, USA; (J.C.C.); (S.S.); (J.B.); (S.T.); (S.G.)
| | - Sheng Sun
- Abzena, 360 George Patterson Boulevard, Bristol, PA 19007, USA; (J.C.C.); (S.S.); (J.B.); (S.T.); (S.G.)
| | - Jeffrey Bos
- Abzena, 360 George Patterson Boulevard, Bristol, PA 19007, USA; (J.C.C.); (S.S.); (J.B.); (S.T.); (S.G.)
| | - Srinath Thirumalairajan
- Abzena, 360 George Patterson Boulevard, Bristol, PA 19007, USA; (J.C.C.); (S.S.); (J.B.); (S.T.); (S.G.)
- Seagen, 21717 30th Drive S.E., Bothell, WA 98021, USA
| | - Sanjeevani Ghone
- Abzena, 360 George Patterson Boulevard, Bristol, PA 19007, USA; (J.C.C.); (S.S.); (J.B.); (S.T.); (S.G.)
| | - Miyako Hirai
- Sartorius Stedim Biotech GmbH, August-Spindler-Straße 11, 37079 Göttingen, Germany; (M.H.); (R.A.B.); (J.S.v.d.H.)
| | - Ricarda A. Busse
- Sartorius Stedim Biotech GmbH, August-Spindler-Straße 11, 37079 Göttingen, Germany; (M.H.); (R.A.B.); (J.S.v.d.H.)
| | - Julia S. v. der Hardt
- Sartorius Stedim Biotech GmbH, August-Spindler-Straße 11, 37079 Göttingen, Germany; (M.H.); (R.A.B.); (J.S.v.d.H.)
| | - Ian Schwartz
- Sartorius North America Inc., 565 Johnson Avenue, Bohemia, NY 11716, USA;
| | - Jieyu Zhou
- Abzena, 360 George Patterson Boulevard, Bristol, PA 19007, USA; (J.C.C.); (S.S.); (J.B.); (S.T.); (S.G.)
- Correspondence: ; Tel.: +1-215-788-3603
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Armas-Phan M, Keihani S, Agochukwu-Mmonu N, Cohen AJ, Rogers DM, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Voelzke B, Moses RA, Sensenig RL, Selph JP, Gupta S, Baradaran N, Erickson BA, Schwartz I, Elliott SP, Mukherjee K, Smith BP, Santucci RA, Burks FN, Dodgion CM, Carrick MM, Askari R, Majercik S, Nirula R, Myers JB, Breyer BN. Clinical and Radiographic Factors Associated With Failed Renal Angioembolization: Results From the Multi-institutional Genitourinary Trauma Study (Mi-GUTS). Urology 2020; 148:287-291. [PMID: 33129870 DOI: 10.1016/j.urology.2020.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To find clinical or radiographic factors that are associated with angioembolization failure after high-grade renal trauma. MATERIAL AND METHODS Patients were selected from the Multi-institutional Genito-Urinary Trauma Study. Included were patients who initially received renal angioembolization after high-grade renal trauma (AAST grades III-V). This cohort was dichotomized into successful or failed angioembolization. Angioembolization was considered a failure if angioembolization was followed by repeat angiography and/or an exploratory laparotomy. RESULTS A total of 67 patients underwent management initially with angioembolization, with failure in 18 (27%) patients. Those with failed angioembolization had a larger proportion ofgrade IV (72% vs 53%) and grade V (22% vs 12%) renal injuries. A total of 53 patients underwent renal angioembolization and had initial radiographic data for review, with failure in 13 cases. The failed renal angioembolization group had larger perirenal hematoma sizes on the initial trauma scan. CONCLUSION Angioembolization after high-grade renal trauma failed in 27% of patients. Failed angioembolization was associated with higher injury grade and a larger perirenal hematoma. Likely these characteristics are associated with high-grade renal trauma that may be less amenable to successful treatment after a single renal angioembolization.
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Affiliation(s)
- Manuel Armas-Phan
- School of Medicine, University of California-San Francisco, San Francisco, CA; Department of Urology, Emory University, Atlanta, GA
| | - Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | | | - Andrew J Cohen
- Department of Urology, University of California-San Francisco, San Francisco, CA; Department of Urology, James Buchanan Brady Urological Institute, Baltimore, MD
| | | | - Sherry S Wang
- Department of Radiology, University of Utah, Salt Lake City, UT
| | - Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA
| | - Ryan P Joyce
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA
| | - Judith C Hagedorn
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA
| | | | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Rachel L Sensenig
- Department of Surgery, Division of Trauma, Cooper University Hospital, Camden, NJ
| | - J Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Shubham Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Ian Schwartz
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Brian P Smith
- Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Auburn Hills, MI
| | | | | | - Reza Askari
- Department of Surgery, Division of Trauma, Brigham and Women's Hospital, Boston, MA
| | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Salt Lake City, UT
| | - Raminder Nirula
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA.
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7
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Keihani S, Putbrese BE, Rogers DM, Zhang C, Nirula R, Luo-Owen X, Mukherjee K, Morris BJ, Majercik S, Piotrowski J, Dodgion CM, Schwartz I, Elliott SP, DeSoucy ES, Zakaluzny S, Sherwood BG, Erickson BA, Baradaran N, Breyer BN, Fick CN, Smith BP, Okafor BU, Askari R, Miller B, Santucci RA, Carrick MM, Kocik JF, Hewitt T, Burks FN, Heilbrun ME, Myers JB. The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal trauma: Results from the Multi-Institutional Genitourinary Trauma Study. J Trauma Acute Care Surg 2019; 86:974-982. [PMID: 31124895 DOI: 10.1097/ta.0000000000002254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Indications for intervention after high-grade renal trauma (HGRT) remain poorly defined. Certain radiographic findings can be used to guide the management of HGRT. We aimed to assess the associations between initial radiographic findings and interventions for hemorrhage after HGRT and to determine hematoma and laceration sizes predicting interventions. METHODS The Genitourinary Trauma Study is a multicenter study including HGRT patients from 14 Level I trauma centers from 2014 to 2017. Admission computed tomography scans were categorized based on multiple variables, including vascular contrast extravasation (VCE), hematoma rim distance (HRD), and size of the deepest laceration. Renal bleeding interventions included angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Mixed-effect Poisson regression was used to assess the associations. Receiver operating characteristic analysis was used to define optimal cutoffs for HRD and laceration size. RESULTS In the 326 patients, injury mechanism was blunt in 81%. Forty-seven (14%) patients underwent 51 bleeding interventions, including 19 renal angioembolizations, 16 nephrectomies, and 16 other procedures. In univariable analysis, presence of VCE was associated with a 5.9-fold increase in risk of interventions, and each centimeter increase in HRD was associated with 30% increase in risk of bleeding interventions. An HRD of 3.5 cm or greater and renal laceration depth of 2.5 cm or greater were most predictive of interventions. In multivariable models, VCE and HRD were significantly associated with bleeding interventions. CONCLUSION Our findings support the importance of certain radiographic findings in prediction of bleeding interventions after HGRT. These factors can be used as adjuncts to renal injury grading to guide clinical decision making. LEVEL OF EVIDENCE Prognostic and Epidemiological Study, Level III and Therapeutic/Care Management, Level IV.
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Affiliation(s)
- Sorena Keihani
- From the Division of Urology, Department of Surgery (S.K., J.B.M.), Department of Radiology (B.E.P., D.M.R.), Division of Epidemiology, Department of Internal Medicine (C.Z.), Department of Surgery (R.N.), University of Utah, Salt Lake City, Utah; Division of Acute Care Surgery (X. L-O, K.M), Loma Linda University Medical Center, Loma Linda, California; Division of Trauma and Surgical Critical Care (B.J.M., S.M), Intermountain Medical Center, Murray, Utah; Department of Urology (J.P.), Department of Surgery (C.M.D.), University of Wisconsin, Milwaukee, Wisconsin; Department of Urology (I.S., S.P.E.), Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota; Department of Surgery (E.S.D.); Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery (S.Z.), University of California Davis Medical Center, Sacramento, California; Department of Urology (B.G.S., BA.E), University of Iowa, Iowa City, Iowa; Department of Urology (N.B., B.N.B.), University of California-San Francisco, San Francisco, California; Division of Trauma and Surgical Critical Care (C.N.F., B.P.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Department of Surgery (B.U.O., R.A.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Urology (B.M., R.A.S), Detroit Medical Center, Detroit, Michigan; Medical City Plano (M.M.C.), Plano; Department of Surgery (J.F.K.), East Texas Medical Center, Tyler, Texas; Department of Urology (T.H., F.N.B.), Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Radiology and Imaging Sciences (M.E.H.), Emory University Hospital, Atlanta, Georgia
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8
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Schwartz I, Denning D. The estimated burden of fungal diseases in South Africa. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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9
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Hippach MB, Schwartz I, Pei J, Huynh J, Kawai Y, Zhu MM. Fluctuations in dissolved oxygen concentration during a CHO cell culture process affects monoclonal antibody productivity and the sulfhydryl‐drug conjugation process. Biotechnol Prog 2018; 34:1427-1437. [DOI: 10.1002/btpr.2697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/29/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Michael B. Hippach
- Process Sciences and ManufacturingAgensys, Inc. 1800 Stewart Street, Santa Monica California 90404
| | - Ian Schwartz
- Process Sciences and ManufacturingAgensys, Inc. 1800 Stewart Street, Santa Monica California 90404
| | - Jian Pei
- Process Sciences and ManufacturingAgensys, Inc. 1800 Stewart Street, Santa Monica California 90404
| | - Jimmy Huynh
- Process Sciences and ManufacturingAgensys, Inc. 1800 Stewart Street, Santa Monica California 90404
| | - Yasuaki Kawai
- Process Science Lab I, Biotechnology Labs, Astellas Pharma, Inc. 5‐2‐3, Tokodai, Tsukuba‐shi, Ibaraki 300‐2698 Japan
| | - Marie M. Zhu
- Process Sciences and ManufacturingAgensys, Inc. 1800 Stewart Street, Santa Monica California 90404
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Moses RA, Selph JP, Voelzke BB, Piotrowski J, Eswara JR, Erickson BA, Gupta S, Dmochowski RR, Johnsen NV, Shridharani A, Blaschko SD, Elliott SP, Schwartz I, Harris CR, Borawski K, Figler BD, Osterberg EC, Burks FN, Bihrle W, Miller B, Santucci RA, Breyer BN, Flynn B, Higuchi T, Kim FJ, Broghammer JA, Presson AP, Myers JB. An American Association for the Surgery of Trauma (AAST) prospective multi-center research protocol: outcomes of urethral realignment versus suprapubic cystostomy after pelvic fracture urethral injury. Transl Androl Urol 2018; 7:512-520. [PMID: 30211041 PMCID: PMC6127553 DOI: 10.21037/tau.2017.11.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Pelvic fracture urethral injuries (PFUI) occur in up to 10% of pelvic fractures. It remains controversial whether initial primary urethral realignment (PR) after PFUI decreases the incidence of urethral obstruction and the need for subsequent urethral procedures. We present methodology for a prospective cohort study analyzing the outcomes of PR versus suprapubic cystostomy tube (SPT) after PFUI. Methods A prospective cohort trial was designed to compare outcomes between PR (group 1) and SPT placement (group 2). Centers are assigned to a group upon entry into the study. All patients will undergo retrograde attempted catheter placement; if this fails a cystoscopy exam is done to confirm a complete urethral disruption and attempt at gentle retrograde catheter placement. If catheter placement fails, group 1 will undergo urethral realignment and group 2 will undergo SPT. The primary outcome measure will be the rate of urethral obstruction preventing atraumatic passage of a flexible cystoscope. Secondary outcome measures include: subsequent urethral interventions, post-injury complications, urethroplasty complexity, erectile dysfunction (ED) and urinary incontinence rates. Results Prior studies demonstrate PR is associated with a 15% to 50% reduction in urethral obstruction. Ninety-six men (48 per treatment group) are required to detect a 15% treatment effect (80% power, 0.05 significance level, 20% loss to follow up/death rate). Busy trauma centers treat complete PFUI approximately 1–6 times per year, thus our goal is to recruit 25 trauma centers and enroll patients for 3 years with a goal of 100 or more total patients with complete urethral disruption. Conclusions The proposed prospective multi-institutional cohort study should determine the utility of acute urethral realignment after PFUI.
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Affiliation(s)
- Rachel A Moses
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - John Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bryan B Voelzke
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Joshua Piotrowski
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jairam R Eswara
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Shubham Gupta
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niels V Johnsen
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anand Shridharani
- Department of Urology, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | | | - Sean P Elliott
- Division of Urology, Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Ian Schwartz
- Division of Urology, Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Kristy Borawski
- Department of Urology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Bradley D Figler
- Department of Urology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - E Charles Osterberg
- Department of Surgery, University of Texas, Dell Medical School, Austin, TX, USA
| | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | - Brandi Miller
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | | | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Brian Flynn
- Department of Surgery (Urology), University of Colorado School of Medicine, Aurora, CO, USA
| | - Ty Higuchi
- Department of Surgery (Urology), University of Colorado School of Medicine, Aurora, CO, USA
| | - Fernando J Kim
- Department of Surgery (Urology), University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua A Broghammer
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Angela P Presson
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
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11
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Keihani S, Moses R, Xu Y, Putbrese B, Rogers D, Luo-Owen X, Mukherjee K, Morris B, Majercik S, Piotrowski J, Dodgion C, Sherwood B, Erickson B, Schwartz I, Elliott S, DeSoucy E, Zakaluzny S, Baradaran N, Breyer B, Smith B, Miller B, Santucci R, Carrick M, Kocik J, Hewitt T, Burks F, Heilbrun M, Hotaling J, Presson A, Nirula R, Myers J. MP25-18 IMAGING FINDINGS ASSOCIATED WITH RENAL BLEEDING INTERVENTIONS AFTER HIGH-GRADE RENAL TRAUMA: RESULTS FROM THE AMERICAN ASSOCIATION FOR SURGERY OF TRAUMA (AAST) GENITO-URINARY TRAUMA STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Oliveira MR, Schwartz I, Costa LS, Maia H, Ribeiro M, Guerreiro LB, Acosta A, Rocha NS. Quality of life in mucopolysaccharidoses: construction of a specific measure using the focus group technique. BMC Res Notes 2018; 11:28. [PMID: 29334993 PMCID: PMC5769464 DOI: 10.1186/s13104-018-3157-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/11/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the perceptions of patients, their caregivers, and their healthcare providers to the development of a new specific instrument for assessment of the quality of life (QoL) in patients with mucopolysaccharidoses (MPS) using a qualitative focus group (FG) design. FGs were held in two Brazilian states (Rio Grande do Sul and Rio de Janeiro). RESULTS Three versions of the new instrument were developed, each for a different age group: children (age 8-12 years), adolescents (age 13-17), and adults (age ≥ 18). The FGs mostly confirmed the relevance of items. All FGs unanimously agreed on the facets: School, Happiness, Life Prospects, Religiosity, Pain, Continuity of Treatment, Trust in Treatment, Relationship with Family, Relationship with Healthcare Providers, Acceptance, and Meaning of Life. The overall concept of QoL (as proposed by the WHO-World Health Organization) and its facets apply to this patient population. However, other specific facets-particularly concerning clinical manifestations and the reality of the disease-were suggested, confirming the need for the development of a specific QoL instrument for MPS.
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Affiliation(s)
- M R Oliveira
- Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil
| | - I Schwartz
- Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil
| | - L S Costa
- Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil
| | - H Maia
- Universidade Federal Fluminense, Rua Miguel de Frias, 9 Icaraí, Niterói, RJ, 24220-008, Brazil
| | - M Ribeiro
- Universidade Federal do Rio de Janeiro, Av. Pedro Calmon, 550, Cidade Universitária, Rio de Janeiro, RJ, 21941-901, Brazil
| | - L B Guerreiro
- Universidade Federal Fluminense, Rua Miguel de Frias, 9 Icaraí, Niterói, RJ, 24220-008, Brazil
| | - A Acosta
- Universidade Federal da Bahia, R. Auristides, 2, Federacao, Salvador, BA, 40210-340, Brazil
| | - N S Rocha
- Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil. .,, Ramiro Barcelos, 2400 2º andar, Porto Alegre, RS, 90 003-035, Brazil.
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13
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Narayan VM, Adejoro O, Schwartz I, Ziegelmann M, Elliott S, Konety BR. The Prevalence and Impact of Urinary Marker Testing in Patients with Bladder Cancer. J Urol 2017; 199:74-80. [PMID: 28859894 DOI: 10.1016/j.juro.2017.08.097] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Novel urinary tumor markers for bladder cancer may permit early detection and improved oncologic outcomes but data on use is limited. We sought to identify trends in the application of urinary markers and long-term outcomes of urinary tumor marker use in patients with bladder cancer. MATERIALS AND METHODS Data from the SEER (Surveillance, Epidemiology and End Results)-Medicare database from 2001 to 2011 were used to identify a cohort of 64,450 patients with bladder cancer who underwent urinary marker testing with UroVysion® fluorescence in situ hybridization, or the NMP22® or BTA Stat® test. We assessed the prevalence of urinary marker testing and urine cytology. Characteristics of patients who did and did not undergo urinary marker testing were analyzed by the chi-square test. Urinary marker testing predictors were analyzed with a multivariable logistic regression model and Cox proportional hazards were used to determine unadjusted cancer specific and overall mortality risks. RESULTS The rate of urinary marker testing increased from 17.8% to a peak of 28.2% during the study years (p <0.0001). Predictors of marker use included female gender, younger age and lower Charlson score. Overall and cancer specific survival improved on Kaplan-Meier and Cox proportional hazards analyses with urinary marker testing. CONCLUSIONS Increased urinary marker testing was documented over all stages and grades of bladder cancer, and in certain patient and provider variables. This increase may have contributed to improved overall and cancer specific survival. Additional investigation is necessary to further characterize this benefit.
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Affiliation(s)
- Vikram M Narayan
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | | | - Ian Schwartz
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | | | - Sean Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
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14
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Southard V, Roumba S, Schwartz I, Sparacino N, Weddingfeld K, Donoghue J. DOES WHOLE-BODY PERIODIC ACCELERATION REDUCE NON-MOTOR SYMPTOMS IN PERSONS WITH PARKINSON’S DISEASE? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V. Southard
- Physical Therapy, NYIT, Old Westbury, New York,
| | - S. Roumba
- Physical Therapy, NYIT, Old Westbury, New York,
| | - I. Schwartz
- Physical Therapy, NYIT, Old Westbury, New York,
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15
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Margos G, Marosevic D, Cutler S, Derdakova M, Diuk-Wasser M, Emler S, Fish D, Gray J, Hunfeld KP, Jaulhac B, Kahl O, Kovalev S, Kraiczy P, Lane RS, Lienhard R, Lindgren PE, Ogden NH, Ornstein K, Rupprecht T, Schwartz I, Sing A, Straubinger RK, Strle F, Voordouw M, Rizzoli A, Stevenson B, Fingerle V. Corrigendum: There is inadequate evidence to support the division of the genus Borrelia. Int J Syst Evol Microbiol 2017; 67:2073. [PMID: 28665266 DOI: 10.1099/ijsem.0.002100] [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] [Indexed: 11/18/2022] Open
Affiliation(s)
- G Margos
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - D Marosevic
- European Programme for Public Health Microbiology Training, European Centre of Disease Prevention and Control (ECDC), Stockholm, Sweden.,National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - S Cutler
- School of Health Sport and Bioscience, University of East London, Water Lane, London, UK
| | - M Derdakova
- Department of Zoology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - M Diuk-Wasser
- Department of Ecology, Evolution and Environmental Biology, Columbia University, 1200 Amsterdam Avenue, New York, NY 10027, USA
| | - S Emler
- SmartGene Services SARL, Innovation Park, Building C, EPFL-Ecublens, CH-1015 Lausanne, Switzerland
| | - D Fish
- Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College Street, New Haven, CT 06510, USA
| | - J Gray
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR).,Emeritus Professor of Animal Parasitology, University College Dublin, Dublin, Ireland
| | - K-P Hunfeld
- Zentralinstitut für Labormedizin, Mikrobiologie and Krankenhaushygiene, Krankenhaus Nordwest, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität, Steinbacher Hohl 2-26, D-60488 Frankfurt am Main, Frankfurt, Germany.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - B Jaulhac
- Laboratoire de Bactériologie, CNR des Borrelia, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg et Faculté de Médecine de Strasbourg, 1 rue Koeberlé, Strasbourg 67000, France.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - O Kahl
- tick-radar GmbH, Haderslebener Str. 9, Berlin 12163, Germany.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - S Kovalev
- Molecular Genetics Lab (www.dnk-ural.ru) Biology Department, Ural Federal University named after the first President of Russia B.N.Yeltsin, Lenin Avenue, Yekaterinburg 620000, Russia
| | - P Kraiczy
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str, Frankfurt/Main 40, 60596, Germany
| | - R S Lane
- Environmental Science, Policy and Management, University of California Berkeley, 130 Mulford Hall, Berkeley CA 94720, California, USA
| | - R Lienhard
- Borrelia Laboratory for the National Reference Centre of Tick Diseases (CNRT/ NRZK), ADMed Microbiology, La Chaux-de-Fonds 2303, Switzerland
| | - P E Lindgren
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - N H Ogden
- Director, Public Health Risk Sciences Division, National Microbiology Laboratory, @ Saint-Hyacinthe and Guelph, Public Health Agency of Canada, Saint-Hyacinthe, Canada
| | - K Ornstein
- Clinical and Experimental Infectious Medicine Section, Department of Clinical Sciences, Lund University, Sweden.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - T Rupprecht
- Klinikum Dachau, Abt. Neurology u. Schlafmedizinisches Zentrum, Krankenhausstr. 15, 8521 Dachau, Germany.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - I Schwartz
- Department of Microbiology and Immunology, School of Medicine, New York Medical College, Basic Sciences Building, Valhalla, NY 10595, USA
| | - A Sing
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - R K Straubinger
- Chair Bacteriology and Mykology, Department of Veterinary Science, Veterinary Faculty, LMU Munich, Veterinärstraße, München 13, 80539, Gemany
| | - F Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - M Voordouw
- Université de Neuchâtel, Institut de Biologie, Laboratoire d'Ecologie et Evolution des Parasites, Rue Emile-Argand 11, CH-2000, Neuchâtel, Switzerland
| | - A Rizzoli
- Fondazione Edmund Mach, Research and Innovation Centre, Via Mach, 1, San Michele all'Adige, Trento, Italy
| | - B Stevenson
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, MS421 Chandler Medical Center, Lexington, Kentucky, 40536-0298, USA
| | - V Fingerle
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR).,National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
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16
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Margos G, Marosevic D, Cutler S, Derdakova M, Diuk-Wasser M, Emler S, Fish D, Gray J, Hunfeldt KP, Jaulhac B, Kahl O, Kovalev S, Kraiczy P, Lane RS, Lienhard R, Lindgren PE, Ogden N, Ornstein K, Rupprecht T, Schwartz I, Sing A, Straubinger RK, Strle F, Voordouw M, Rizzoli A, Stevenson B, Fingerle V. There is inadequate evidence to support the division of the genus Borrelia. Int J Syst Evol Microbiol 2017; 67:1081-1084. [PMID: 27930271 DOI: 10.1099/ijsem.0.001717] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- G Margos
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - D Marosevic
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
- European Programme for Public Health Microbiology Training, European Centre of Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - S Cutler
- School of Health Sport and Bioscience, University of East London, Water Lane, London, UK
| | - M Derdakova
- Department of Zoology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - M Diuk-Wasser
- Department of Ecology, Evolution and Environmental Biology, Columbia University, 1200 Amsterdam Avenue, New York, NY 10027, USA
| | - S Emler
- SmartGene Services SARL, Innovation Park, Building C, EPFL-Ecublens, CH-1015 Lausanne, Switzerland
| | - D Fish
- Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College Street, New Haven, CT 06510, USA
| | - J Gray
- Emeritus Professor of Animal Parasitology, University College Dublin, Dublin, Ireland
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
| | - K-P Hunfeldt
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Zentralinstitut für Labormedizin, Mikrobiologie and Krankenhaushygiene, Krankenhaus Nordwest, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität, Steinbacher Hohl 2-26, D-60488 Frankfurt am Main, Frankfurt, Germany
| | - B Jaulhac
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Laboratoire de Bactériologie, CNR des Borrelia, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg et Faculté de Médecine de Strasbourg, 1 rue Koeberlé, Strasbourg 67000, France
| | - O Kahl
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- tick-radar GmbH, Haderslebener Str. 9, Berlin 12163, Germany
| | - S Kovalev
- Molecular Genetics Lab (www.dnk-ural.ru) Biology Department, Ural Federal University named after the first President of Russia B.N.Yeltsin, Lenin Avenue, Yekaterinburg 620000, Russia
| | - P Kraiczy
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str, Frankfurt/Main 40, 60596, Germany
| | - R S Lane
- Environmental Science, Policy and Management, University of California Berkeley, 130 Mulford Hall, Berkeley CA 94720, California, USA
| | - R Lienhard
- Borrelia Laboratory for the National Reference Centre of Tick Diseases (CNRT/ NRZK), ADMed Microbiology, La Chaux-de-Fonds 2303, Switzerland
| | - P E Lindgren
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - N Ogden
- Director, Public Health Risk Sciences Division, National Microbiology Laboratory, @ Saint-Hyacinthe and Guelph, Public Health Agency of Canada, Saint-Hyacinthe, Canada
| | - K Ornstein
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Clinical and Experimental Infectious Medicine Section, Department of Clinical Sciences, Lund University, Sweden
| | - T Rupprecht
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Klinikum Dachau, Abt. Neurology u. Schlafmedizinisches Zentrum, Krankenhausstr. 15, 8521 Dachau, Germany
| | - I Schwartz
- Department of Microbiology and Immunology, School of Medicine, New York Medical College, Basic Sciences Building, Valhalla, NY 10595, USA
| | - A Sing
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - R K Straubinger
- Chair Bacteriology and Mykology, Department of Veterinary Science, Veterinary Faculty, LMU Munich, Veterinärstraße, München 13, 80539, Gemany
| | - F Strle
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Voordouw
- Université de Neuchâtel, Institut de Biologie, Laboratoire d'Ecologie et Evolution des Parasites, Rue Emile-Argand 11, CH-2000, Neuchâtel, Switzerland
| | - A Rizzoli
- Fondazione Edmund Mach, Research and Innovation Centre, Via Mach, 1, San Michele all'Adige, Trento, Italy
| | - B Stevenson
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, MS421 Chandler Medical Center, Lexington, Kentucky, 40536-0298, USA
| | - V Fingerle
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany
- Members of the Steering Committee of the ESCMID Study Group for Borrelia (ESGBOR)
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Elhanan E, Boaz M, Schwartz I, Schwartz D, Chernin G, Soetendorp H, Gal Oz A, Agbaria A, Weinstein T. A randomized, controlled clinical trial to evaluate the immunogenicity of a PreS/S hepatitis B vaccine Sci-B-Vac™, as compared to Engerix B ®, among vaccine naïve and vaccine non-responder dialysis patients. Clin Exp Nephrol 2017; 22:151-158. [PMID: 28456864 DOI: 10.1007/s10157-017-1416-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 04/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dialysis patients have a suboptimal response to hepatitis B (HBV) vaccination. This study aimed to compare the immunogenicity of two vaccines: the third-generation Sci-B-Vac™ vs. the second-generation Engerix B®. The cohort included two groups of dialysis patients: naïve and previously vaccinated non-responders. Primary endpoints were antibody titers ≥10 IU/L at 3 and 7 month post-vaccination. Secondary objectives were seroprotection rates in vaccine-naïve patients and in previously vaccinated non-responders. METHODS Eighty-six patients were assigned to vaccine (Sci-B-Vac™ or Engerix B®) using computer-generated randomization, stratified by age, gender, diabetes, and previous HBV vaccination. Sci-B-Vac™ was administered in three doses, 10 μg, at 0, 1, and 6 months in naïve patients; or 20 μg in previously vaccinated non-responders. Engerix B® included four doses, 40 μg at 0, 1, 2, and 6 months. RESULTS Each group had 43 patients. Seroconversion was 69.8% with Engerix B® vs. 73.2% with Sci-B-Vac™. Antibody titers at 7 months were higher with Sci-B-Vac™ (266.4 ± 383.9, median 53.4) than with Engerix® (193.2 ± 328.9, median 19). However, these differences were not significant, perhaps due to a suboptimal sample size. CONCLUSIONS This study suggests comparable immunogenicity for both vaccines. Thus, we cannot reject the null hypothesis that there is no difference in seroconversion by vaccine type. It is noteworthy that naïve patients were vaccinated with a standard dose of Sci-B-Vac™, while Engerix B® was administered at a double dose. Similarly, although mean antibody titer levels in the Sci-B-Vac™ group were higher than in the Engerix® group, this difference did not reach significance. Consequently, a future clinical trial should recruit a larger cohort of patients, using a standard double-dose protocol in both groups.
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Affiliation(s)
- E Elhanan
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - M Boaz
- Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel
- Ariel University, Ariel, Israel
| | - I Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - D Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - G Chernin
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - H Soetendorp
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Gal Oz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Agbaria
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - T Weinstein
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel.
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Venkatesh AK, Hajdasz D, Rothenberg C, Dashevsky M, Parwani V, Sevilla M, Shapiro M, Schwartz I. Reducing Unnecessary Blood Chemistry Testing in the Emergency Department: Implementation of Choosing Wisely. Am J Med Qual 2017; 33:81-85. [DOI: 10.1177/1062860617691842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schwartz I, Cogan D, Schmidgall ER, Don Y, Gantz L, Kenneth O, Lindner NH, Gershoni D. Deterministic generation of a cluster state of entangled photons. Science 2016; 354:434-437. [DOI: 10.1126/science.aah4758] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/30/2016] [Indexed: 11/02/2022]
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Abstract
Previous studies indicate that people who are low in self-esteem are more prejudiced (i.e., more negative about outgroups) than people who are high in self esteem. It is not clear from this research, however, whether low self-esteem individuals derogate outgroups relative to the ingroup (i.e., whether they show ingroup favoritism or ethnocentrism). In an experiment using the minimal intergroup situation paradigm, it was found that both high and low self-esteem subjects show ingroup favoritism, although low self-esteem subjects rated both the ingroup and the outgroup more negatively than did high self-esteem subjects. There was no evidence for greater ingroup favoritism among low self-esteem subjects. The results are discussed in terms of the distinction between prejudice and ethnocentrism and the self-enhancing functions of ingroup favoritism.
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Bodor N, Schwartz I, Trinajstić N. SCFMO Study of the Tautomerism of Anilino-Thiazole and Related Compounds. Zeitschrift für Naturforschung B 2014. [DOI: 10.1515/znb-1971-0505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
SCFMO study of the tautomerism of anilino-thiazole, anilino-oxazole, and anilino-oxadiazole shows that amino form predominates.
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Affiliation(s)
- N. Bodor
- Chemical-Pharmaceutical Research Institute, Cluj, Romania,
| | - I. Schwartz
- Medico-Pharmaceutical Institut, Catedra Chimie Fisica, Cluj, Romania,
| | - N. Trinajstić
- Institute “Rudjer Bošković”, Zagreb, Croatia, Yugoslavia
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Portnoy S, Schwartz I. Gait characteristics of post-poliomyelitis patients: Standardization of quantitative data reporting. Ann Phys Rehabil Med 2013; 56:527-41. [PMID: 23891005 DOI: 10.1016/j.rehab.2013.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 06/24/2013] [Accepted: 06/29/2013] [Indexed: 01/03/2023]
Affiliation(s)
- S Portnoy
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Mount Scopus, Jerusalem 91240, Israel; Department of Occupational Therapy, Tel Aviv University, Tel Aviv, Israel.
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Schwartz I, Kandel L, Sajina A, Litinezki D, Herman A, Mattan Y. Balance is an important predictive factor for quality of life and function after primary total knee replacement. ACTA ACUST UNITED AC 2012; 94:782-6. [PMID: 22628592 DOI: 10.1302/0301-620x.94b6.27874] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated the extent to which improved balance relative to pain relief correlates with the success of total knee replacement (TKR). A total of 81 patients were recruited to the study: 16 men (19.8%) and 65 women (80.2%). Of these, 62 patients (10 men, 52 women) with a mean age of 73 (57 to 83) underwent static and dynamic assessment of balance pre-operatively and one year post-operatively. The parameters of balance were quantified using commercially available and validated equipment. Motor function and self-reported outcome were also assessed. There was a significant improvement in dynamic balance (p < 0.001) one year after TKR, and better balance correlated with improved mobility, functional balance and increased health-related quality of life. As it seems that balance, and not only pain relief, influences the success of TKR, balance skills should be better addressed during the post-operative rehabilitation of patients who undergo TKR.
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Affiliation(s)
- I Schwartz
- Hadassah-Hebrew University Medical Center, Department of Physical Medicine and Rehabilitation, P.O. Box 24035, Jerusalem 91240, Israel
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Yi Chun DX, Alexandre H, Edith B, Nacera O, Julie P, Chantal J, Eric R, Zhang X, Jin Y, Miravete M, Dissard R, Klein J, Gonzalez J, Caubet C, Pecher C, Pipy B, Bascands JL, Mercier-Bonin M, Schanstra J, Buffin-Meyer B, Claire R, Rigothier C, Richard D, Sebastien L, Moin S, Chantal B, Christian C, Jean R, Migliori M, Migliori M, Cantaluppi V, Mannari C, Medica D, Giovannini L, Panichi V, Goldwich A, Alexander S, Andre G, Amann K, Migliorini A, Sagrinati C, Angelotti ML, Mulay SR, Ronconi E, Peired A, Romagnani P, Anders HJ, Chiang WC, Lai CF, Peng WH, Wu CF, Chang FC, Chen YT, Lin SL, Chen YM, Wu KD, Lu KS, Tsai TJ, Virgine O, Qing Feng F, Zhang SY, Dominique D, Vincent A, Marina C, Philippe L, Georges G, Pawlak A, Sahali D, Matsumoto S, Kiyomoto H, Ichimura A, Dan T, Nakamichi T, Tsujita T, Akahori K, Ito S, Miyata T, Xie S, Zhang B, Shi W, Yang Y, Nagasu H, Satoh M, Kidokoro K, Nishi Y, Ihoriya C, Kadoya H, Sasaki T, Kashihara N, Wu CF, Chang FC, Chen YT, Chou YH, Duffield J, Lin SL, Rocca C, Rocca C, Gregorini M, Corradetti V, Valsania T, Bedino G, Bosio F, Pattonieri EF, Esposito P, Sepe V, Libetta C, Rampino T, Dal Canton A, Bedino G, Gregorini M, Corradetti V, Rocca C, Pattonieri EF, Valsania T, Bosio F, Esposito P, Sepe V, Libetta C, Rampino T, Dal Canton A, Omori H, Kawada N, Inoue K, Ueda Y, Yamamoto R, Matsui I, Kaimori J, Takabatake Y, Moriyama T, Isaka Y, Rakugi H, Wasilewska A, Taranta-Janusz K, Deebek W, Kuroczycka-Saniutycz E, Lee AS, Lee AS, Lee JE, Jung YJ, Kang KP, Lee S, Kim W, Arfian N, Emoto N, Yagi K, Nakayama K, Hartopo AB, Nugrahaningsih DA, Yanagisawa M, Hirata KI, Munoz-Felix JM, Lopez-Novoa JM, Martinez-Salgado C, Oujo B, Munoz-Felix JM, Arevalo M, Bernabeu C, Perez-Barriocanal F, Lopez-Novoa JM, Jesper K, Nathalie V, Pierre G, Yi Chun DX, Alexandre H, Eric R, Iyoda M, Shibata T, Matsumoto K, Shindo-Hirai Y, Kuno Y, Wada Y, Akizawa T, Schwartz I, Schwartz D, Prot Bertoye C, Prot Bertoye C, Terryn S, Claver J, Beghdadi WB, Monteiro R, Blank U, Devuyst O, Daugas E, Van Beneden K, Geers C, Pauwels M, Mannaerts I, Van den Branden C, Van Grunsven LA, Seckin I, Pekpak M, Uzunalan M, Uruluer B, Kokturk S, Ozturk Z, Sonmez H, Yaprak E, Furuno Y, Tsutsui M, Morishita T, Shimokawa H, Otsuji Y, Yanagihara N, Kabashima N, Ryota S, Kanegae K, Miyamoto T, Nakamata J, Ishimatsu N, Tamura M, Nakagawa T, Nakagawa T, Ichikawa K, Miyamoto M, Takabayashi D, Yamazaki H, Kakeshita K, Koike T, Kagitani S, Tomoda F, Hamashima T, Ishii Y, Inoue H, Sasahara M, El Machhour F, Kerroch M, Mesnard L, Chatziantoniou C, Dussaule JC, Inui K, Sasai F, Maruta Y, Nishiwaki H, Kawashima E, Inoue Y, Yoshimura A, Matsumoto K, Matsumoto K, Iyoda M, Shibata T, Wada Y, Shindo-Hirai Y, Kuno Y, Akizawa T, Musacchio E, Priante G, Valvason C, Sartori L, Baggio B, Kim JH, Gross O, Diana R, Gry DH, Asimal B, Johanna T, Imke SE, Lydia W, Gerhard-Anton M, Hassan D, Cano JL, Griera M, Olmos G, Martin P, Cortes MA, Lopez-Ongil S, Rodriguez-Puyol D, DE Frutos S, Gonzalez M, DE Frutos S, Cano JL, Luengo A, Martin P, Rodriguez-Puyol M, Calleros L, Lupica R, Lacquaniti A, Donato V, Maggio R, Mastroeni C, Lucisano S, Cernaro V, Fazio MR, Quartarone A, Buemi M, Kacik M, Goedicke S, Eggert H, Hoyer JD, Wurm S, Wurm S, Steege A, Banas M, Kurtz A, Banas B, Lasagni L, Lazzeri E, Peired A, Angelotti ML, Ronconi E, Romoli S, Romagnani P, Schaefer I, Teng B, Worthmann K, Haller H, Schiffer M, Prattichizzo C, Netti GS, Rocchetti MT, Cormio L, Carrieri G, Stallone G, Grandaliano G, Ranieri E, Gesualdo L, Kucher A, Smirnov A, Parastayeva M, Beresneva O, Kayukov I, Zubina I, Ivanova G, Abed A, Schlekenbach L, Foglia B, Chatziantoniou C, Kwak B, Chadjichristos C, Queisser N, Schupp N, Brand S, Himer L, Himer L, Szebeni B, Sziksz E, Saijo S, Kis E, Prokai A, Banki NF, Fekete A, Tulassay T, Vannay A, Hegner B, Schaub T, Lange C, Dragun D, Klinkhammer BM, Rafael K, Monika M, Anna M, Van Roeyen C, Boor P, Eva Bettina B, Simon O, Esther S, Floege J, Kunter U, Hegner B, Janke D, Schaub T, Lange C, Jankowski J, Dragun D, Hayashi M, Takamatsu I, Horimai C, Yoshida T, Seno DI Marco G, Koenig M, Stock C, Reiermann S, Amler S, Koehler G, Fobker M, Buck F, Pavenstaedt H, Lang D, Brand M, Plotnikov E, Morosanova M, Pevzner I, Zorova L, Pulkova N, Zorov D, Wornle M, Ribeiro A, Belling F, Merkle M, Nakazawa D, Nishio S, Shibasaki S, Tomaru U, Akihiro I, Kobayashi I, Imanishi Y, Kurajoh M, Nagata Y, Yamagata M, Emoto M, Michigami T, Ishimura E, Inaba M, Nishi Y, Satoh M, Sasaki T, Kashihara N, Wu CC, Lu KC, Chen JS, Chu P, Lin YF, Eller K, Schroll A, Banas M, Kirsch A, Huber J, Weiss G, Theurl I, Rosenkranz AR, Zawada A, Rogacev K, Achenbach M, Fliser D, Held G, Heine GH, Miyamoto Y, Iwao Y, Watanabe H, Kadowaki D, Ishima Y, Chuang VTG, Sato K, Otagiri M, Maruyama T, Ueda Y, Iwatani H, Isaka Y, Watanabe H, Honda D, Miyamoto Y, Noguchi T, Kadowaki D, Ishima Y, Tanaka M, Tanaka H, Fukagawa M, Otagiri M, Maruyama T, Wornle M, Ribeiro A, Pircher J, Koppel S, Mannell H, Krotz F, Merkle M, Virzi GM, Bolin C, Cruz D, Scalzotto E, De Cal M, Vescovo G, Ronco C, Virzi GM, Bolin C, Cruz D, Scalzotto E, De Cal M, Vescovo G, Ronco C, Grobmayr R, Lech M, Ryu M, Anders HJ, Aoshima Y, Mizobuchi M, Ogata H, Kumata C, Nakazawa A, Kondo F, Ono N, Koiwa F, Kinugasa E, Akizawa T, Freisinger W, Lale N, Lampert A, Ditting T, Heinlein S, Schmieder RE, Veelken R, Nave H, Perthel R, Suntharalingam M, Bode-Boger S, Beutel G, Kielstein J, Rodrigues-Diez R, Rodrigues-Diez R, Rayego-Mateos S, Lavoz C, Stark Aroeira LG, Orejudo M, Alique M, Ortiz A, Egido J, Ruiz-Ortega M, Oskar W, Rusan C, Schaub T, Hegner B, Dragun D, Padberg JS, Wiesinger A, Brand M, Seno DI Marco G, Reuter S, Grabner A, Kentrup D, Lukasz A, Oberleithner H, Pavenstadt H, Kumpers P, Eberhardt HU, Skerka C, Chen Q, Hallstroem T, Hartmann A, Kemper MJ, Zipfel PF, N'gome-Sendeyo K, Fan QF, Zhang SY, Pawlak A, Sahali D, Wornle M, Ribeiro A, Merkle M, Toblli J, Toblli J, Cao G, Giani JF, Dominici FP, Kim JS, Yang JW, Kim MK, Han BG, Choi SO. Experimental pathology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs241] [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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Schwartz I, Adejoro O, Elliott S, Slaton J. 926 THE VALUE OF INGUINAL LYMPH NODE DISSECTION IN PATIENTS WITH SQUAMOUS PENILE CANCER: AN ANALYSIS OF THE SEER DATABASE. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Meiner Z, Cohen JE, Gomori JM, Sajin A, Schwartz I, Tsenter J, Yovchev I, Eichel R, Ben-Hur T, Leker RR. Rehabilitation outcomes of stroke patients treated with multi-modal endovascular reperfusion therapy. Eur J Phys Rehabil Med 2012; 48:31-37. [PMID: 21602761] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of this study was to investigate the influence of multi-modal endovascular reperfusion therapy (MMRT) on functional outcomes following rehabilitation. METHODS Data from 14 MMRT-treated patients were analyzed and compared to MMRT-ineligible, age and stroke severity-matched patients treated at the same Neurological and Rehabilitation departments. Neurological evaluation was assessed with the NIH stroke scale (NIHSS). Activity of daily living was measured using the FIMTM instrument. Functional outcome was measured using the modified Rankin scale (mRS). RESULTS The baseline characteristics of both groups were similar. NIHSS scores were lower in the MMRT group and they had slightly better functional and rehabilitation scores on admission to rehabilitation. At the end of rehabilitation, more MMRT-treated patients reached functional independence (mRS≤2; 50% vs. 7% respectively P=0.03). FIM scores were also higher in the MMRT group (mean score 93.3 vs. 87.7, respectively) but the difference did not reach significance. The delta in FIM and NIHSS scores obtained during rehabilitation did not significantly differ between the groups. MMRT remained a significant modifier of good outcome after regression analysis (OR 21.5 95% CI 1.1-410). CONCLUSION MMRT-treated patients have better chances of attaining independence after rehabilitation therapy. However, the additional improvements gained while in active rehabilitation were independent of reperfusion status.
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Affiliation(s)
- Z Meiner
- Departments of Physical Medicine and Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Liveris D, Schwartz I, McKenna D, Nowakowski J, Nadelman RB, DeMarco J, Iyer R, Cox ME, Holmgren D, Wormser GP. Quantitation of cell-associated borrelial DNA in the blood of Lyme disease patients with erythema migrans. Eur J Clin Microbiol Infect Dis 2011; 31:791-5. [PMID: 21842448 DOI: 10.1007/s10096-011-1376-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] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
Bloodstream invasion is an important event in the pathogenesis of the more serious manifestations of Lyme disease. The number of spirochetes in the blood of infected patients, however, has not been determined, and, therefore, it is unknown whether the number of spirochetes can be correlated with particular clinical or laboratory features. This study was designed to measure the level of Borrelia burgdorferi in the plasma of Lyme disease patients and correlate these levels with selected clinical and laboratory findings. Nested and quantitative polymerase chain reaction (qPCR) was employed to detect cell-associated flaB gene DNA in the plasma of untreated early Lyme disease patients with erythema migrans (EM). Twenty-nine (45.3%) of 64 patients had evidence of B. burgdorferi in their plasma by at least one of the PCR methods. For the 22 qPCR-positive patients, the mean number of flaB gene copies per mL of plasma was 4,660, with a range of 414 to 56,000. The number of flaB gene copies did not significantly correlate with any of the clinical, demographic, or laboratory variables assessed. For reasons discussed, we suggest caution in extrapolating an estimate of the number of viable Borrelia in plasma from the observed number of flaB copies.
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Affiliation(s)
- D Liveris
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY 10595, USA
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Monico EP, Forman HP, Goodman TR, Schwartz I, Larkin GL. A survey of policies and procedures on the communication and documentation of radiologic interpretations. J Healthc Risk Manag 2011; 30:23-7. [PMID: 21351193 DOI: 10.1002/jhrm.20057] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research into emergency medicine (EM) diagnostic errors identified imaging as a contributing factor in 94% of cases. Discrepancies between the preliminary (trainee) and the final (attending) diagnostic imaging interpretation represent a system issue that is particularly prone to creating diagnostic errors. Understanding the types of systematic communication and documentation strategies developed by academic radiology departments to address differences between preliminary and final radiology interpretations to clinicians are threshold steps toward minimizing this risk. This study investigates policies and practices associated with the communication and documentation of preliminary and final radiologic interpretations among U.S. academic radiology departments through a questionnaire directed at radiology department chairs.
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Affiliation(s)
- Edward P Monico
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut, USA
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Abstract
The "wet-read" consultation has been defined as a rapid response to a clinical question posed by a physician to a radiologist. These preliminary interpretations are often not well documented, have poor fidelity, and are subject to modifications and revisions. Moreover, preliminary interpretations may be subject to reinterpretation through a variety of scenarios. Recent technological advances in radiology have further hindered the ability to harmonize differences between preliminary and final interpretations and communicate these differences to treating physicians. High-fidelity simulation may represent a risk management strategy aimed at bridging the gap between radiology and communication technology.
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Affiliation(s)
- Edward Monico
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Abstract
Patients leaving the emergency department (ED) against medical advice (AMA) represent 0.1% to 2.7% of all ED patients. These patients create significant angst for emergency physicians because these patients frequently have serious underlying medical pathology and tend to represent a higher-than-average source of medical-legal liability than other ED patients. This article attempts to mitigate these risks by reviewing what we know about AMA encounters from the ED and providing documentation guidelines for the encounter.
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John A, Fagondes S, Schwartz I, Azevedo A, Barrios P, Dalcin P, Barreto S, Giugliani R. 259 SLEEP EVALUATION IN PATIENTS WITH MUCOPOLYSACCHARIDOSIS TYPE VI. Sleep Med 2009. [DOI: 10.1016/s1389-9457(09)70261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pat-Horenczyk R, Machyevsky D, Brom D, Schwartz I, Inbar M, Rice A, Wexler I, Corn B. Dyadic coping among breast cancer patients treated with radiotherapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20589] [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
e20589 Background: Cancer poses a major stressor for patients and their partners. Understanding dyad coping is useful for determining if one partner's involvement is beneficial or harmful to the other. We sought to evaluate whether dyadic coping enhances resilience in the context of other risk and protective factors for coping with serious illness. Methods: An IRB-approved questionnaire was offered to breast cancer patients and their spouses. Consent was obtained from 21 dyads who were queried prior to initiation of breast irradiation and within 2 weeks of completing treatment. The nature of dyadic coping (positive or negative), level of posttraumatic stress, functional impairment, depression, and markers of resiliency were assessed for each partner at the beginning and conclusion of therapy. Results: Depression was significantly higher in patients than in their spouses (df = 1, 13; F = 6.13; p = 0.028). Over the course of the radiotherapy, partner's depression improved while the patient's depression worsened (df=1,13; F=5.46; p=0.030). The patient's negative dyadic coping assessment before radiation therapy was positively associated with depression (β = 0.78; df = 31.3; t = 2.15; p = 0.04), as well as the partner's depression (β = 0.92; df = 31.3; t = 2.52; p = 0.017) and posttraumatic stress (β = 0.74; df = 31.7; t = 2.10; p = 0.04). Patient's pre-radiation negative dyadic coping was negatively associated with the partner's flexibility (β = -.21; df = 19; t = -2.28; p = 0.03) and self efficacy (β = 0.46; df = 21.8; t = 2.96; p = 0.007) at completion of therapy. Positive dyadic coping assessment was not associated with negative coping behaviors on the part of either the patient or partner. Conclusions: The results of this pilot study support interventions incorporating dyadic support to enhance the resilience of patients and partners. Intervention should promote flexibility and self-efficacy while providing tools for altering negative dyadic coping patterns. No significant financial relationships to disclose.
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Affiliation(s)
- R. Pat-Horenczyk
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - D. Machyevsky
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - D. Brom
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - I. Schwartz
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - M. Inbar
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - A. Rice
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - I. Wexler
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
| | - B. Corn
- Herzog Hospital, Jerusalem, Israel; Tel Aviv Medical Center, Tel Aviv, Israel; Hadassah Hospital, Jerusalem, Israel
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Moreh E, Meiner Z, Neeb M, Hiller N, Schwartz I. Spinal decompression sickness presenting as partial brown-sequard syndrome and treated with robotic-assisted body-weight support treadmill training. J Rehabil Med 2009; 41:88-9. [DOI: 10.2340/16501977-0279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pevni D, Frolkis I, Schwartz D, Schwartz I, Chernichovski T, Kramer A, Ben-Gal Y, Uretzky G, Shapira I, Weinbroum A. New evidence for the role of TNF-alpha in liver ischaemic/reperfusion injury. Eur J Clin Invest 2008; 38:649-55. [PMID: 18837741 DOI: 10.1111/j.1365-2362.2008.01996.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tumour necrosis factor-alpha (TNF-alpha) plays a key role in causing ischaemia/reperfusion (I/R) injury. I/R also causes activation of xanthine oxidase and dehydrogenase (XDH + XO) system that, via generated free radicals, causes organ damage. We investigated the effect of ischaemia, reperfusion and non-ischaemic prolonged perfusion (NIP) on TNF-alpha and XDH + XO production in an isolated perfused rat liver model. MATERIALS AND METHODS Rat livers underwent 150 min NIP (control group) or two hours of ischaemia followed by reperfusion (I/R group). TNF-alpha (TNF-alpha mRNA and protein level), XDH + XO production and bile secretion were determined in tissue and effluent at baseline, at 120 min of ischaemia, after 30 min of reperfusion (I/R group) and after 120 and 150 min of prolonged perfusion (control). RESULTS Unexpectedly, neither ischaemia nor reperfusion had any effect on TNF-alpha production. TNF-alpha in effluent was 11 +/- 4.8 pg mL(-1) at baseline, 7 +/- 3.2 pg mL(-1) at the end of ischaemia, and 13 +/- 5.3 pg mL(-1) after 30 min of reperfusion. NIP, however, caused a significant increase of TNF-alpha synthesis and release. TNF-alpha effluent level after 120 and 150 min of perfusion was 392 +/- 78.7 pg mL(-1) and 408 +/- 64.3 pg mL(-1), respectively. TNF-alpha mRNA in tissue was also significantly elevated compared to baseline levels (1.31 +/- 0.2 P < 0.001 and 1.38 P < 0.002, respectively). Decrease of liver function (expressed by bile secretion) during I/R and NIP was accompanied by significant XDH + XO elevation. CONCLUSION This is the first evidence that NIP, and not I/R, is the decisive trigger for TNF-alpha production. This study leads to a better understanding of pathogenesis of liver I/R and perfusion damage.
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Affiliation(s)
- D Pevni
- Department of Cardiac Surgery, Tel-Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Chu J, Schwartz I. eToims twitch relief method in chronic refractory myofascial pain (CRMP). Electromyogr Clin Neurophysiol 2008; 48:311-320. [PMID: 18837197] [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: 05/26/2023]
Abstract
INTRODUCTION CRMP management involves electrical stimulation of motor points. OBJECTIVE To demonstrate that Electrical Twitch-Obtaining Intramuscular Stimulation (eToims) using ET127 system for noninvasive motor point stimulation is safe and efficacious in CRMP management. METHOD Longitudinal observation of consecutive self-pay outpatients treated from 10/06 through 4/08, divided into Preferred Group ("PG", N = 49, 3 Hz, 4 stimuli/site) and Basic Group ("BG", N = 43, 1 Hz stimulation, 1 stimulus/site). PG and BG had comparable ages, symptom durations, treatment session durations and treatment intervals. Each session involved treatment to large muscles of C4-C7 and L3-S1 myotomes. Outcome measures include prior week's verbal pain levels, pre and immediate post-session pain levels, blood pressure (BP), pulse rate (PR), symptomatic (S) and asymptomatic (A) side range-of-motion (ROM) for neck rotation (NR), shoulder external rotation (ER), shoulder internal rotation (IR), straight leg raising (SLR) and FABERE testing. RESULTS PG and BG showed significant improvements (p < 0.01) in immediate post-session pain levels and measured ROM. Significantly higher ERS (pre and post session percentage changes) noted for BG over PG (p < 0.05). Post-session PR decreased in both groups, more so in PG Systolic BP was mildly elevated in PG but was mildly reduced in BG Both groups showed no diastolic BP changes. Significant negative correlation noted between increasing number of treatments and pain level only in PG (r = -0.3, p = 0.00). Increasing number of treatments in PG correlated significantly with improvement in NRS, NRA, IRS, SLRS, LRA, FABERES and FABEREA whereas BG significantly correlated only for improvement in LRS. PG had lower average pain levels than BG (3.4 +/- 1.9 vs. 4.3 +/- 2.5, p < 0.02). CONCLUSION eToims using ET127 electrical stimulator appears safe and efficacious in CRMP management.
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Affiliation(s)
- J Chu
- Department of Physial Medicine and Rehabilitation, University of Pennsylvania School of Medicine, USA.
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Portlock CS, Hamlin P, Noy A, Chey W, Gaydos CA, Palomba L, Schwartz I, Corcoran S, Rosenzweig L, Walker D, Papanicolaou G, Markowitz A. Infectious disease associations in advanced stage, indolent lymphoma (follicular and nonfollicular): developing a lymphoma prevention strategy. Ann Oncol 2007; 19:254-8. [PMID: 17965114 DOI: 10.1093/annonc/mdm484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Eradication of Helicobacter pylori in gastric mucosa-associated lymphoid tumor can result in lymphoma remission. We prospectively identified/treated infections in nonbulky, advanced stage indolent lymphoma (follicular; nonfollicular lymphoma) eligible for observation. MATERIALS AND METHODS Stool H. pylori, hepatitis C and Borrelia serologies, Borrelia and Chlamydia fixed tissue PCR, Chlamydia peripheral blood mononuclear cell PCR and hydrogen breath test for small bowel bacterial overgrowth (SBBO) were obtained. RESULTS Fifty-six patients were enrolled. Positive infections: H. pylori (13); hepatitis C (3); SBBO (11). Negative: Borrelia (13); Chlamydophila psittaci (12, except one PCR). Lymphoma responses to antimicrobial therapy: H. pylori [one complete response (CR), 24+ months; one transient near CR]; hepatitis C [two CRs, 18+ and 30+ months; one partial response (PR) but hepatitis C virus persistent]; SBBO (one PR, 30+ months). Patients with associated infections, but without lymphoma CR, have required lymphoma treatment sooner than those without initial infections (treatment-free survival at 23.4 months median follow-up, 40.5% versus 74.7%, P = 0.01), indicating a different biology. CONCLUSION Infections are common in advanced stage indolent lymphoma (37.5% in our series). Anecdotal lymphoma responses have been seen and three have been durable CRs (18 to 30+ months) with infection eradication alone. The identification and treatment of associated infections may be a first step towards developing a lymphoma prevention strategy.
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Affiliation(s)
- C S Portlock
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY 10021, USA.
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Steiner I, Wirguin I, Blumen SC, Dano M, Raphaeli G, Schwartz I, Korn-Lubetzki I. 'Hyperacute' Guillain-Barré syndrome. Eur Neurol 2007; 59:88-90. [PMID: 17934279 DOI: 10.1159/000109575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 03/31/2007] [Indexed: 11/19/2022]
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Feder HM, Johnson BJB, O'Connell S, Shapiro ED, Steere AC, Wormser GP, Agger WA, Artsob H, Auwaerter P, Dumler JS, Bakken JS, Bockenstedt LK, Green J, Dattwyler RJ, Munoz J, Nadelman RB, Schwartz I, Draper T, McSweegan E, Halperin JJ, Klempner MS, Krause PJ, Mead P, Morshed M, Porwancher R, Radolf JD, Smith RP, Sood S, Weinstein A, Wong SJ, Zemel L. A critical appraisal of "chronic Lyme disease". N Engl J Med 2007; 357:1422-30. [PMID: 17914043 DOI: 10.1056/nejmra072023] [Citation(s) in RCA: 397] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Henry M Feder
- Department of Family Medicine and Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA.
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Chavatte-Palmer P, Heyman Y, Schwartz I. 26 EFFECTS OF SOMATIC CLONING ON THE IMMUNE RESPONSE IN YOUNG AND ADULT CATTLE. Reprod Fertil Dev 2006. [DOI: 10.1071/rdv18n2ab26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Somatic cloning in cattle is associated with important gestational abnormalities, including implantation delay during the first 2 months of pregnancy and abnormal fetal and placental growth (known as large offspring syndrome, or LOS) in the third trimester. In our laboratory, between 3 and 25% of the cloned blastocysts transferred to recipient cows reach term, depending on genotype. About 20% of the newborns die rapidly due to various causes that appear to be direct consequences of the LOS. We previously reported on a thymic atrophy resulting from nuclear transfer (Renard et al. 1999 Lancet 353, 1459-1491) and have further diagnosed distinct pathological events occurring in the infancy and adult age of clones, including death due to apparently benign infections (despite treatment) and also thymic atrophy in approximately 20% of the postmortem cases. These observations in clones have led us to investigate the immune function of apparently normal bovine clones. Holstein cows housed in the same farm were used. Circulating lymphocyte populations during the resting state were marked, counted in 17 clones and 17 contemporary controls ranging from 15 days to 5 years of age, and allotted to one of three groups: 1 (0.5-2 months, n = 4 clones, n = 6 controls), 2 (3-9 months, n = 7 clones, n = 5 controls) and 3 (1.5-5 years, n = 6 clones, n = 6 controls). Clones originated from adult fibroblast cells from four different genotypes distributed in the three groups. Peripheral mononuclear blood cells (PMBCs) were collected, marked, and counted by flow cytometry. The specific markers were CD2, CD3, CD4, CD8, CD14, CD11b, CD25, CD45RO, P46 (NK cells), ��, PanB, MHC1, and MHC2. In a second experiment, six clones from three different genotypes and six controls aged 8-9 months were vaccinated with 10 mg ovalbumin in alum to evaluate the na�ve immune response. The cell subset proportions were not different between clones and controls. There was no difference between groups for antibody response to vaccination. However, T cell restimulation with specific antigens after immunization with evalbumin was significantly lower in clones compared to controls (P < 0.05). Furthermore, nonspecific stimulation with phytohemagglutinin (PHA) was also lower in clones (P < 0.05). These results show that lymphocyte populations are normally represented in apparently healthy clones. Bovine clones presented, however, a reduced capacity to build up a cellular immune response against a newly encountered antigen, such as ovalbumin. It remains to be determined whether these functional alterations are a result of defective reprogramming of immune functions during the cloning process or the consequence of an abnormal placental development leading to altered feto-placental interactions during pregnancy and fetal programming. Previous work by others has shown that there may be an abnormal expression of MHC1 in the placenta of bovine clones (Hill et al. 2002 Biol. Reprod. 67, 55-63), and this may well be part of the same phenomenon affecting overall immune regulation in clones.
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Weissberg D, Kaufmann M, Schwartz I. Iatrogenic bile duct stricture. Br J Surg 2005. [DOI: 10.1002/bjs.1800731238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- D Weissberg
- Department of Surgery, E. Wolfson Hospital, Holon, Israel
| | - M Kaufmann
- Department of Surgery, E. Wolfson Hospital, Holon, Israel
| | - I Schwartz
- Department of Surgery, E. Wolfson Hospital, Holon, Israel
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Chu J, Eun SS, Schwartz I. Quantitative motor unit action potentials (QMUAP) in whiplash patients with neck and upper-limb pain. Electromyogr Clin Neurophysiol 2005; 45:323-8. [PMID: 16315969] [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: 05/05/2023]
Abstract
INTRODUCTION Needle EMG studies in patients with whiplash symptoms to document presence of neural injury, such as cervical radiculopathy, are not available. OBJECTIVE To document presence of motor unit action potential (MUAP) parameter changes compatible with neurogenic involvement in symptomatic-limb muscles in whiplash induced acute and chronic pain states. DESIGN Retrospective review. SETTING Out patient quantitative electromyography (QEMG) laboratory. PARTICIPANTS 72 consecutive patients (mean age 43.6 years) who underwent QEMG between 1/2001 - 12/2004 for electrodiagnosis of neck and upper-limb pain related to auto-accidents (mean symptom duration 15.3 months). INTERVENTIONS QEMG with MUAP parameter analysis. MAIN OUTCOME MEASURES Amplitude, duration, size-index (SI), percentage of polyphasic units and firing rate analysis in chosen bilateral muscles representing C3-C8 myotomes. RESULTS No spontaneous activity noted in muscles examined. Without subsetting symptom duration, symptomatic-side: asymptomatic-side MUAP parameter comparison showed significant increase in MUAP frequency on the symptomatic-side C6-muscle (10.4 +/- 1.3 vs. 9.7 +/- 1.4, p = < 0.05), and C7 muscle (10.0 +/- 1.2 vs. 9.1 +/- 1.1, p < or = 0.01). The symptomatic-side C6-muscle also showed increased percentage of polyphasic-MUAPs (23.7 +/- 13.1 vs. 15.9 +/- 12.7, p < 0.001). Patients with acute symptom duration (< 6 months, mean duration 3.4 +/- 1.4 months, N=26), showed increased percentage of polyphasic MUAPs in the symptomatic-side C6-muscle (27.0 +/- 12.3% vs. asymptomatic 22.2 +/- 17.6%, p < or = 0.05). In patients with chronic symptom duration (> or =6 months, mean duration 22.0 +/- 17.9 months, N=46), symptomatic-side C6-muscle showed increased polyphasic MUAPs (22.2 +/- 13.2%) vs. asymptomatic (15.5 +/- 11.6%), p < or = 0.02, and higher firing rates (10.3 +/- 1.7 vs. 9.6 +/- 1.3 respectively, p < or = 0.003). CONCLUSIONS QEMG changes suggest neural injury in symptomatic side C6 and C7 innervated muscles, even in the absence of spontaneous activity. In acute and chronic pain patients a higher percentage of polyphasic MUAPs is noted in the symptomatic side C6 muscle. In chronic pain patients higher MUAP frequencies are noted in the symptomatic side C6 muscle.
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Affiliation(s)
- J Chu
- Department of Physical Medicine and Rehabilitation, Hospital of the University of PA, Philadelphia 19104, USA.
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Takehara I, Chu J, Schwartz I, Aye HH. Motor unit action potential (MUAP) parameters affected by editing duration cursors. Electromyogr Clin Neurophysiol 2004; 44:265-9. [PMID: 15378864] [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: 04/30/2023]
Abstract
INTRODUCTION Quantitative electromyography (QEMG) allows fast analysis of motor unit action potential (MUAP) parameters such as amplitude, duration, size index (SI), phases, turns and firing rate. When automated duration cursor placement is incorrect, the electrodiagnostician will manually edit this function potentially introducing bias to the final results. OBJECTIVE To identify that (1) size index is the MUAP parameter least affected by manually editing duration cursors and (2) MUAP amplitude will influence the manual cursor correction rate. MATERIALS AND METHODS Included were twenty-one consecutive patients who had QEMG with monopolar needle electrode for diagnostic evaluation of their myofascial pain symptoms. Evaluated for neck pain included 6 bilateral upper limb and cervical paraspinal muscles and for lower back pain were 5 bilateral lower limb and lower back muscles. Twenty MUAPs were recorded from each muscle and hardcopies of data obtained before and after manual edit. RESULTS Of a total of 5360 MUAPs analyzed 1764 (33%) required manual editing of duration cursors. Cursor correction rate 120 MUAP s/individual muscle analyzed was also similar at 33+/-17%. Percentage change in duration more so than turns, before and after correction, was significantly larger than that of other parameters. No significant differences in percentage changes noted between SI and phases. CONCLUSIONS SI and phases are least influenced by the manual correction of duration cursors since there is insubstantial amplitude and area at the tail-end of the MUAP.
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Affiliation(s)
- I Takehara
- Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Bayard-Mc Neeley M, Bansal A, Chowdhury I, Girao G, Small CB, Seiter K, Nelson J, Liveris D, Schwartz I, Mc Neeley DF, Wormser GP, Aguero-Rosenfeld ME. In vivo and in vitro studies on Anaplasma phagocytophilum infection of the myeloid cells of a patient with chronic myelogenous leukaemia and human granulocytic ehrlichiosis. J Clin Pathol 2004; 57:499-503. [PMID: 15113857 PMCID: PMC1770287 DOI: 10.1136/jcp.2003.011775] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The occurrence of human granulocytic ehrlichiosis (HGE) in a patient with chronic myelogenous leukaemia (CML) provided an opportunity to study whether Anaplasma phagocytophilum, the aetiological agent of HGE, infects mature or immature cells, both in vivo and in vitro. METHODS Diagnosis of HGE was confirmed by culture, polymerase chain reaction (PCR), detection of intragranulocytic inclusions, and serology. The infection rates of different myelogenous stages of granulocytic differentiation were determined by microscopy. Anaplasma phagocytophilum infection of the bone marrow was analysed by PCR, culture, and microscopy. In addition, the in vitro growth of A phagocytophilum in the patient's granulocytes and in HL-60 cells (a promyelocytic leukaemia cell line) was compared. RESULTS Pretreatment blood smears showed that mature granulocytic cells had a higher infection rate with A phagocytophilum than did immature cells. In the original inoculation of the patient's cells into HL-60 cells to isolate A phagocytophilum, the bacterium grew faster in the patient's leukaemic cells than in HL-60 cells. Anaplasma phagocytophilum inclusions were rarely seen in bone marrow granulocytes and PCR was negative. In vitro, two A phagocytophilum isolates grew faster in the patient's granulocytes than in HL-60 cells. CONCLUSIONS The superior growth in CML cells compared with HL-60 cells suggests that A phagocytophilum preferentially infects mature granulocytes. The higher infection rate of the patient's mature versus immature granulocytes before treatment and the minimal level of infection of the patient's bone marrow support this. It is possible that the primary site of infection in HGE is the peripheral mature granulocytic population.
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Affiliation(s)
- M Bayard-Mc Neeley
- Department of Pathology, New York Medical College, Westchester Medical Center, Valhalla, New York 10595, USA
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Sade K, Schwartz I, Schwartz D, Wolman Y, Chernichovski T, Fireman E, Iaina A, Kivity S. Effect of montelukast pretreatment on inducible nitric oxide synthase mRNA expression in the lungs of antigen-challenged allergic mice. Clin Exp Allergy 2004; 33:1741-6. [PMID: 14656364 DOI: 10.1111/j.1365-2222.2003.01798.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Growing evidence suggests that inducible nitric oxide synthase (iNOS) is the main source of the high output of exhaled nitric oxide (NO) in asthma. Treatment of asthmatic patients with glucocorticoids reduces high levels of exhaled NO mainly by inhibiting the transcription of iNOS. A similar reduction in exhaled NO was recently observed in patients treated with the leukotriene receptor antagonists, but the exact interaction between these drugs and iNOS remains obscure. OBJECTIVE The purpose of this study was to evaluate the effect of a leukotriene receptor antagonist, montelukast, on the expression and activity of iNOS in a murine model of allergic asthma. METHODS Twenty-four BALB/c mice were sensitized to OVA and were equally divided into 3 groups (Groups 1-3). Eight additional mice were sham sensitized and served as a negative control group (Group 4). Group 1 received montelukast 1 mg/kg/day in their drinking water, Group 2 received dexamethasone 1 mg/kg/day in their drinking water and Groups 3 and 4 received plain tap water. After 1 week, the animals were challenged by inhalation of OVA and, 3 h later, they were killed and their lung cells were isolated by enzymatic tissue digestion. NO generation was measured by a Griess assay, and iNOS mRNA was studied by RT-PCR. RESULTS A significant increase in iNOS mRNA expression and in NO generation was evident after allergen challenge compared with the controls. Pretreatment with montelukast mildly decreased NO production without producing a concomitant significant decrease in iNOS mRNA expression. CONCLUSION Unlike pretreatment with glucocorticoids, we failed to find compelling evidence for a major role for montelukast treatment in the modulation of iNOS mRNA in a murine model of acute asthma.
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Affiliation(s)
- K Sade
- Department of Pulmonary and Allergic Diseases, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Chu J, Takehara I, Li TC, Schwartz I. Skill and selection bias has least influence on motor unit action potential firing rate/frequency. Electromyogr Clin Neurophysiol 2003; 43:387-92. [PMID: 14626717] [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: 04/27/2023]
Abstract
INTRODUCTION Motor unit action potential (MUAP) rise time in quantitative electromyography (QEMG) using multi-MUAP analysis may influence neuromuscular disease diagnosis. OBJECTIVE To demonstrate in QEMG that MUAP firing rate/frequency (FR) is the parameter least dependent on electrodiagnostician skill (EDXc) skill and selection bias. METHODS AND MATERIALS During minimal contraction (< 6 MUAPs/4.8 s analysis period) of tibialis anterior, 20 MUAPs were selected for QEMG at each of the 3 insertion sites. There were three EDXcs (professor & two fellows), each an independent MUAP selector + EMG machine itself (EMGM), for a total of four independent MUAP selectors. EDXc and selector order variation at each site involved the following. At insertion site1, during EMG by EDXc 1, the MUAP selector order was EDXc 1, EMGM, EDXc 2 and EDXc 3. At the following two sites, the previous 1st selector was sequentially rotated to become the last selector during EMG by the subsequent EDXc. The protocol was repeated in two subjects. MUAP inclusion criteria by EDXcs was MUAP rise time < 1 ms by visual inspection and, by the EMGM, any and all MUAPs during the 4.8 s analysis period. RESULTS The reproducibility of measurements between MUAP selectors for mean frequency was satisfactory (correlation coefficient for inter-EDXc was 0.57, and 0.66 between the most experienced EDXc and EMGM. Inter- EDXc correlation coefficient was poor for amplitude (0.10), duration (0.34), size index (0.35), phases (-0.13) and turns (-0.22). Of the MUAPs collected by EMGM, the mean amplitude was smaller and mean duration was longer than those collected by the other 3 selectors with no significant differences for the other parameters. CONCLUSIONS FR was the only satisfactorily reproduced parameter from QEMG of MUAPs between selectors, and least dependent on skill and/or selection bias. From this, FR appears a relatively objective parameter, while other parameters appear unduly influenced by EDXc skill and/or MUAP selection bias.
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Affiliation(s)
- J Chu
- Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Ground White, Philadelphia, PA 19104-4283, USA.
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Schwartz I, Silva LR, Leistner S, Todeschini LA, Burin MG, Pina-Neto JM, Islam RM, Shah GN, Sly WS, Giugliani R. Mucopolysaccharidosis VII: clinical, biochemical and molecular investigation of a Brazilian family. Clin Genet 2003; 64:172-5. [PMID: 12859417 DOI: 10.1034/j.1399-0004.2003.00119.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Merimsky O, Issakov J, Schwartz I, Kollender Y, Inbar M, Meller I, Bickels J. Lack of c-kit overexpression in soft tissue sarcomas. Isr Med Assoc J 2003; 5:151-2. [PMID: 12674675] [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: 03/01/2023]
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Chu J, Neuhauser DV, Schwartz I, Aye HH. The efficacy of automated/electrical twitch obtaining intramuscular stimulation (atoims/etoims) for chronic pain control: evaluation with statistical process control methods. Electromyogr Clin Neurophysiol 2002; 42:393-401. [PMID: 12395614] [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: 04/19/2023]
Abstract
INTRODUCTION Automated and/or electrical twitch-obtaining intramuscular stimulation (ATOIMS & ETOIMS) evoke twitches at/or near motor end plate zones to relieve muscle pain. OBJECTIVES To demonstrate that pain levels recorded daily by patients enable statistical process control (SPC) analysis of ATOIMS & ETOIMS effects over time. METHODS Four chronic fibromyalgic patients received ATOIMS & ETOIMS treatments to bilateral C3-C8 and L3-S1 myotomes and recorded daily pain on a visual analogue scale. Mechanical stimulation with ATOIMS involved a custom device to insert, oscillate and retract a monopolar needle (MN) at 2 Hz x2s. ETOIMS involved manual insertion of the MN and stimulating with 5 Volts, 0.5 ms pulse duration at 2 Hz for 2s to multiple sites. Positive outcome measures include two pain scales reduction. RESULTS Patient 1-4 had 89, 38, 40, 36 treatments during a follow-up time of 625, 1018, 378, 466 days with 5.4 +/- 3.7, 8.0 +/- 4.9, 4.2 +/- 2.4 and 4.6 +/- 2.7 days between treatments (DBT) during the first 6 months and 4.7 +/- 3.0, 21.8 +/- 15.6, 6.2 +/- 4.4 and 4.3 +/- 2.5 DBT respectively in the latter phase of the therapy. The average pain level (APL) in 1st week of treatment for patient 1-4 were 6.4 +/- 1.1, 3.7 +/- 1.1, 6.6 +/- 2.8 and 7.5 +/- 0.4 and in the last week of treatment were 4.5 +/- 0.4, 1.2 +/- 0.1, 4.2 +/- 1.0 and 4.7 +/- 0.7 respectively. APL correlated negatively with time during the first 6 months for patients 2-4 and also after 6 months for patients 4 & 1 who had unchanged and reduced DBT respectively. APL correlated positively with time for patient 2 with no correlation for patient 3 (both had increased DBT) after 6 months. CONCLUSIONS Patients will chronically record their pain scales daily enabling analysis by SPC. ATOIMS & ETOIMS applied periodically can be helpful in relieving fibromyalgic pain.
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Affiliation(s)
- J Chu
- Department of Rehabilitation Medicine, Ground Floor, White Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Chu J, Gozon BS, Schwartz I. Twitch-obtaining intramuscular stimulation in reflex sympathetic dystrophy. Electromyogr Clin Neurophysiol 2002; 42:259-66. [PMID: 12168246] [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: 02/26/2023]
Abstract
BACKGROUND Reflex Sympathetic Dystrophy (RSD) remains a painful disease entity of undetermined etiology and variable response to therapy. FINDINGS Presented is a patient with left leg early RSD and chronic musculoskeletal back pain who received automated and electrical twitch-obtaining intramuscular stimulation (ATOIMS & ETOIMS) treatments. Diagnosis combined clinical symptoms of pain and allodynia, signs of motor/trophic changes and electromyographic evidence of especially of left L5 root level irritation, with chronic bilateral, multiple level partial lumbosacral nerve root involvement. Signs and symptoms of early RSD resolved with therapy. CONCLUSIONS ATOIMS-ETOIMS have a promising role in the treatment of early RSD associated with neuropathic pain resulting from spondylotic radiculopathy.
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Affiliation(s)
- J Chu
- Dept. of Rehabilitation Medicine, University of Pennsylvania Medical Center, Ground Floor, White Building, 3400 Spruce Street, Phila., PA 19104, USA.
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Chu J, Schwartz I. The muscle twitch in myofascial pain relief: effects of acupuncture and other needling methods. Electromyogr Clin Neurophysiol 2002; 42:307-11. [PMID: 12168251] [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: 02/26/2023]
Abstract
Proposed is that needling methods such as acupuncture, primarily effect pain relief in myofascial pain through a local mechanism, elicitation of muscle twitches. Occasionally, diagnostic needling procedures such as electromyography (EMG) can relieve such pain through insertional intramuscular movements of the needle electrode. This results in stimulation of the motor end-plate zones (MEPZs), eliciting muscle twitches. As needle elicitation of muscle twitches is a common diagnostic technique to identify myofascial trigger points (MTrPs), muscle twitches elicited at such points may be therapeutic, not just diagnostic. Occasionally evoked small local muscle twitches are observed in pain relieving methods using needle penetration or manipulation, such as classical or electrical acupuncture and intramuscular stimulation (IMS). Twitch elicitation has been observed to be essential to obtain myofascial pain relief associated with the needling methods of automated and electrical twitch-obtaining intramuscular stimulation (ATOIMS and ETOIMS). These two methods facilitate the elicitation of larger force twitches by mechanical or electrical stimulation respectively at motor end-plate zones.
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Affiliation(s)
- J Chu
- Department of Rehabilitation Medicine, Ground Floor, White Building, Hospital of the University of PA, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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