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Furin J, Farmer P, Wolf M, Levy B, Judd A, Paternek M, Hurtado R, Katz J. A novel training model to address health problems in poor and underserved populations. J Health Care Poor Underserved 2006; 17:17-24. [PMID: 16520503 DOI: 10.1353/hpu.2006.0023] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Health disparities are increasingly common and many U.S. practitioners have informal experience working in resource-poor settings. There are, however, few graduate medical education programs that focus on health equity. A graduate medical education program in health equity was developed at Brigham and Women's Hospital based on a review of existing literature and on a survey of junior faculty who have had informal health disparities experience. The Howard Hiatt Residency in Global Health Equity and Internal Medicine was developed as a four-year program to provide intensive training in internal medicine and health disparities. Participating residents are matched with a mentor who has clinical and research experience in the field of global health. In addition to a series of didactic teaching sessions and longitudinal seminars that focus on issues of global health equity, residents take graduate level courses in epidemiology, health policy, ethics, and medical anthropology. Residents also carry out an independent research project in a geographic area that suffers from health disparities. Two residents are selected for training per year. Participating faculty are multidisciplinary and come from diverse Harvard-affiliated institutions. Graduate medical education in the United States with a focus on health equity is lacking. It is hoped that the novel training program in health equity for internal medical residents developed at Brigham and Women's Hospital can serve as a model for other teaching hospitals based in the United States.
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179
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Hargrove R, Ridgeway S, Russell R, Norris M, Packham I, Levy B. Does pulse lavage reduce hip hemiarthroplasty infection rates? J Hosp Infect 2006; 62:446-9. [PMID: 16488057 DOI: 10.1016/j.jhin.2005.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 07/06/2005] [Indexed: 11/30/2022]
Abstract
This paper reports a prospective randomized trial involving four hospitals in the south of England, in which every hemiarthroplasty (American Association of Anaesthetists grade IV and above) was randomized to one of two limbs. In the first group, the patients received a 2-L pulse lavage normal saline washout; in the second group, they received a 2-L normal saline washout via a jug or a syringe. All wounds were reviewed during their time in hospital up to 30 days post surgery or discharge (using criteria from the Nosocomial Infection National Surveillance Survey). Any re-admissions for infection were recorded. The pulse lavage group had a significantly lower total infection rate and, specifically, a decreased 'joint space' or deep infection rate.
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180
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Chudnoff S, Levie M, Levy B, Bronx SD. 99. J Minim Invasive Gynecol 2005. [DOI: 10.1016/j.jmig.2005.07.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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181
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Callum P, Copperman A, Scott R, Levy B. Assessment of Patient Awareness of Preimplantation Genetic Diagnosis (PGD) Benefits and Limitations. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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182
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Wen PY, Schiff D, Doherty L, Gigas D, Musikansky A, Bradshaw J, Levy B, Kesari S, Ramakrishna N, Maher E, Black P. A phase II study of prolonged daily temozolomide for low-grade glioma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.1522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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183
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184
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Shanske AL, Edelmann L, Kardon NB, Gosset P, Levy B. Detection of an interstitial deletion of 2q21-22 by high resolution comparative genomic hybridization in a child with multiple congenital anomalies and an apparent balanced translocation. ACTA ACUST UNITED AC 2004; 131:29-35. [PMID: 15368480 DOI: 10.1002/ajmg.a.30311] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Various molecular cytogenetic techniques are currently available to accurately characterize chromosome rearrangements in patients with multiple congenital anomalies. Among these is comparative genomic hybridization (CGH) whose main advantage is the ability to perform a whole genome scan without prior knowledge of the underlying chromosome abnormality. It has been used mostly in the area of cancer cytogenetics, but its role in clinical genetics is now expanding to even include preimplantation genetic diagnosis. We have used this method to reveal an interstitial deletion in a patient with multiple anomalies, who had for years been thought to have a de novo balanced translocation involving chromosomes 1 and 2. A review of published reports suggests that there is significant phenotypic and genetic heterogeneity in the small group of patients including our own with interstitial deletions of 2q21-q22.
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185
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Kakkis E, McEntee M, Vogler C, Le S, Levy B, Belichenko P, Mobley W, Dickson P, Hanson S, Passage M. Intrathecal enzyme replacement therapy reduces lysosomal storage in the brain and meninges of the canine model of MPS I. Mol Genet Metab 2004; 83:163-74. [PMID: 15464431 DOI: 10.1016/j.ymgme.2004.07.003] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Revised: 07/05/2004] [Accepted: 07/07/2004] [Indexed: 11/19/2022]
Abstract
Enzyme replacement therapy (ERT) has been developed for several lysosomal storage disorders, including mucopolysaccharidosis I (MPS I), and is effective at reducing lysosomal storage in many tissues and in ameliorating clinical disease. However, intravenous ERT does not adequately treat storage disease in the central nervous system (CNS), presumably due to effects of the blood-brain barrier on enzyme distribution. To circumvent this barrier, we studied whether intrathecal (IT) recombinant human alpha-L-iduronidase (rhIDU) could penetrate and treat the brain and meninges. An initial dose-response study showed that doses of 0.46-4.14 mg of IT rhIDU successfully penetrated the brain of normal dogs and reached tissue levels 5.6 to 18.9-fold normal overall and 2.7 to 5.9-fold normal in deep brain sections lacking CSF contact. To assess the efficacy and safety in treating lysosomal storage disease, four weekly doses of approximately 1 mg of IT rhIDU were administered to MPS I-affected dogs resulting in a mean 23- and 300-fold normal levels of iduronidase in total brain and meninges, respectively. Quantitative glycosaminoglycan (GAG) analysis showed that the IT treatment reduced mean total brain GAG to normal levels and achieved a 57% reduction in meningeal GAG levels accompanied by histologic improvement in lysosomal storage in all cell types. The dogs did develop a dose-dependent immune response against the recombinant human protein and a meningeal lymphocytic/plasmacytic infiltrate. The IT route of ERT administration may be an effective way to treat the CNS disease in MPS I and could be applicable to other lysosomal storage disorders.
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186
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Levy B, Richter K, Vermilyea M, Bolkas M, Tucker M. Multicenter experience with transfers of embryos produced by rescue intracytoplasmic sperm injection (ICSI) performed on late-maturing oocytes and on oocytes following failed conventional insemination. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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187
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Shah G, Kesari S, Xu R, Henson J, Batchelor T, Hochberg F, Oneill A, Levy B, Bradshaw J, Wen PY. Comparison of 1D, 2D, 3D and volumetric parameters in measuring tumor response in high-grade gliomas in adults. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.1523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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188
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Brahimi M, Dabire H, Levy B. DETERMINANTS OF LEFT VENTRICULAR MASS IN PATENTS WITH END STAGE RENAL FAILURE UNDERGOING HEMODIALYSIS. J Hypertens 2004. [DOI: 10.1097/00004872-200406002-01008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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189
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Miller K, Elkind-Hirsch K, Ross S, Levy B, Scott R. Gender does not impact the developmental rate of in vitro fertilization-derived human embryos as confirmed by day 3 blastomere biopsy and preimplantation genetic diagnosis (PGD). Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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190
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Levkoff S, Levy B, Weitzman PF. The role of religion and ethnicity in the help seeking of family caregivers of elders with Alzheimer's disease and related disorders. J Cross Cult Gerontol 2004; 14:335-56. [PMID: 14618013 DOI: 10.1023/a:1006655217810] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Stages of help seeking during illness have been identified as follows: disease experience, symptom attribution, decision to seek care, and contact with care providers. These stages have not been evaluated amongst family caregivers of elders affected with Alzheimer's disease and related disorders (ADRD). Since minority families typically care for ADRD elders at home, it seems important to understand the help seeking of minority family caregivers in particular, and the role of religious/ethnic factors. Thematic analyses were conducted on in-depth interviews from 10 caregivers from 4 groups (total n = 40): African-American, Chinese-American, Puerto Rican, and Irish-American. Aside from the disease experience stage, where religious/ethnic themes were negligible, between-group differences existed in these themes at other stages. For example, themes of extended family support emerged around decision making, with much between-group variation. At the contact with providers stage themes of contacting religious or ethnic service organizations were present, again with between-group variation. Chinese-American and Puerto Rican narratives contained themes of language barriers to care, and a lack of culturally-competent services. Both Irish-American and African-American narratives showed themes of alienation from religious groups on the one hand, and using prayer to cope on the other. Narratives from all groups contained themes of religious and/or ethnic imperatives for providing care. Overall, findings reveal that religious/ethnic factors may both aid and impede the help seeking of caregivers.
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191
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Serhan CN, Levy B. Novel pathways and endogenous mediators in anti-inflammation and resolution. CHEMICAL IMMUNOLOGY AND ALLERGY 2003; 83:115-45. [PMID: 12947982 DOI: 10.1159/000071558] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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192
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Serhan CN, Levy B. Success of prostaglandin E2 in structure-function is a challenge for structure-based therapeutics. Proc Natl Acad Sci U S A 2003; 100:8609-11. [PMID: 12861081 PMCID: PMC166355 DOI: 10.1073/pnas.1733589100] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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193
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Levy B, Ashman O, Dror I. To be or not to be: the effects of aging stereotypes on the will to live. OMEGA-JOURNAL OF DEATH AND DYING 2003; 40:409-20. [PMID: 12557880 DOI: 10.2190/y2ge-bvyq-nf0e-83vr] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined whether stereotypes of aging might contribute to decisions the elderly make about when to die. Old and young participants (N=64) were subliminally primed with either negative or positive stereotypes of old age and then responded to hypothetical medical situations involving potentially fatal illnesses. Consistent with our prediction, the aged participants primed with negative stereotypes tended to refuse life-prolonging interventions, whereas the old participants primed with positive age stereotypes tended to accept the interventions. This priming effect did not emerge among the young participants for whom the stereotypes were less relevant. The results suggest that societally-transmitted negative stereotypes of aging can weaken elderly people's will to live.
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194
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Wautier MP, Massin P, Guillausseau PJ, Huijberts M, Levy B, Boulanger E, Laloi-Michelin M, Wautier JL. N(carboxymethyl)lysine as a biomarker for microvascular complications in type 2 diabetic patients. DIABETES & METABOLISM 2003; 29:44-52. [PMID: 12629447 DOI: 10.1016/s1262-3636(07)70006-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Hyperglycemia is linked to vascular dysfunction in patients with diabetes mellitus, either directly or through advanced glycation end product (AGE) formation. Experimental evidence has indicated the possible involvement of AGEs in the genesis of vascular complications. We investigated whether serum levels of AGEs and of the glycoxidation compound carboxymethyl-lysine (CML) were increased and correlated with vascular complications in type II diabetes mellitus. METHODS Serum levels of AGEs and CML-human serum protein (CML-HSP) were measured by a specific immunoassay in 51 men and 26 women aged 58 +/- 6.1 years (mean +/- SD) who had been treated for type II diabetes mellitus for 11 +/- 8 years, and in a non-diabetic control group consisting of 39 men and 21 women aged 55.5 +/- 7.5 years. Patients with macroalbuminuria or abnormal creatinine clearance were excluded from the study. RESULTS The serum levels of AGEs were significantly increased in patients with type II diabetes compared to controls (P<0.001). Blood levels of CML-HSP were significantly increased in diabetic patients compared to normal subjects [35.3 +/- 27.4 and 9.3 +/- 7.2 (mean +/- SD) pmol/mg of protein, respectively; P<0.0001]. In diabetic patients with retinopathy or microalbuminuria (urinary albumin excretion: UAE > 30 mg/24 h), CML-HSP levels were significantly higher (P<0.02), and even more elevated in patients with both complications. CONCLUSION In patients with type II diabetes, CML-HSP levels that are at variance with the HbA(1c) index for blood glucose may be a biomarker of glycoxidation, and related to the development of microvascular complications.
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195
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Cohen A, Levy B, Katz Y. Sesame allergy: Natural history and long-term follow-up. J Allergy Clin Immunol 2003. [DOI: 10.1016/s0091-6749(03)80903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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196
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Michel P, Moradpour A, Penven P, Firlej L, Bernier P, Levy B, Ravy S, Zahab A. Ring-strain-modified properties of substituted perylene radical cation salts. A solid-state carbon-13 CPMAS NMR study. J Am Chem Soc 2002. [DOI: 10.1021/ja00179a011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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197
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Rose JS, Fisch BJ, Hogan WR, Levy B, Marshall P, Thomas DR, Kirkley D. Common medical terminology comes of age, Part Two: Current code and terminology sets--strengths and weaknesses. JOURNAL OF HEALTHCARE INFORMATION MANAGEMENT : JHIM 2002; 15:319-30. [PMID: 11642148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
A number of clinical coding and vocabulary schemes are in use in healthcare enterprises today. Most of them are weak in light of the qualities that characterize adequate controlled medical terminologies, as outlined in Part One of this review. Here we look at the major code and terminology sets with a critical eye, as well as suggest practical steps to enable health industry information system purchasers and users to move forward with their effort to use common terminology to improve the quality, service, and knowledge in their enterprise.
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Rose JS, Fisch BJ, Hogan WR, Levy B, Marshal P, Thomas DR, Kirkley D. Common medical terminology comes of age, Part One: Standard language improves healthcare quality. JOURNAL OF HEALTHCARE INFORMATION MANAGEMENT : JHIM 2002; 15:307-18. [PMID: 11642147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
It has become abundantly clear that standards of recording clinical terms in human-readable, computer-processable format are indispensable. Controlled medical terminology is the missing link in health information standards (in fact, medical terminology can be viewed as the mother of all standards); its absence interferes with the business of healthcare and impedes the core processes of healing and maintaining health. Medicine has lacked the controlled common medical vocabulary that would enable universal sharing of data at the point of care and ensure reliable information for determining health intervention effectiveness. Simple clinical and code content alone has proven insufficient for healthcare enterprises to successfully manage the terminology problem; the "lexical runtime engine," formerly called a vocabulary server (VOSER), which manages the vocabulary ontology and serves up the relevant vocabulary to users of applications in the clinical environment, has recently become a reality.
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199
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Sramek JJ, Leibowitz MT, Weinstein SP, Rowe ED, Mendel CM, Levy B, McMahon FG, Mullican WS, Toth PD, Cutler NR. Efficacy and safety of sibutramine for weight loss in obese patients with hypertension well controlled by beta-adrenergic blocking agents: a placebo-controlled, double-blind, randomised trial. J Hum Hypertens 2002; 16:13-9. [PMID: 11840225 DOI: 10.1038/sj.jhh.1001299] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sibutramine is a serotonin-noradrenaline reuptake inhibitor that is effective for long-term weight reduction and maintenance in obese patients when used as an adjunct to dietary and behavioural measures. Because the inhibition of noradrenaline reuptake may be expected to increase systolic and diastolic blood pressure (SBP and DBP) and pulse rate (PR), a 12-week multi-centre, placebo-controlled, double-blind study was designed to evaluate the efficacy and tolerability of sibutramine for weight loss in obese patients whose hypertension was well controlled (DBP < or = 95 mm Hg) by beta-adrenergic blocking agents (beta-blockers), with or without concomitant thiazide diuretics. Of the 61 patients randomised to sibutramine 20 mg once daily or placebo, 55 patients (90%) completed the study. After 12 weeks, sibutramine-treated patients lost significantly more weight than placebo-treated patients: mean weight reductions were 4.2 kg (4.5%) in the sibutramine group vs 0.3 kg (0.4%) in the placebo group (P<0.001). Greater weight reduction on sibutramine was accompanied by trends for greater mean reductions in serum triglycerides and very low density lipoprotein cholesterol. Sibutramine was well tolerated, and most adverse events were mild or moderate in severity. No sibutramine patient discontinued treatment because of an adverse event. Mean supine and standing DBP and SBP were not statistically significantly different between the sibutramine group and the placebo group at any post-baseline visit during the 12-week trial. At week 12, mean increases from baseline supine SBP and DBP, respectively, were 1.6 and 1.7 mm Hg for the sibutramine group vs increases of 0.4 and 1.3 mm Hg for the placebo group. At week 12, mean increases from baseline standing SBP and DBP, respectively, were 1.5 and 1.8 mm Hg for the sibutramine group vs an increase of 0.3 and a decrease of 0.8 mm Hg for the placebo group (P > 0.05 for treatment comparison). A statistically significant mean increase of 5.6 bpm (+/-8.25, s.d.) in supine PR from a baseline of 62 bpm was reported in sibutramine-treated patients at week 12, whereas placebo-treated patients had a mean supine PR decrease of 2.2 bpm (+/-6.43) (P < 0.001). In summary, sibutramine was well tolerated and effective in weight reduction. The addition of sibutramine did not result in an increase in BP in obese patients whose hypertension was well controlled by a beta-blocker. However, based on the potential for changes in BP and PR, obese patients being treated with sibutramine should be monitored periodically for changes in BP and PR and managed appropriately.
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200
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Sands MS, Vogler CA, Ohlemiller KK, Roberts MS, Grubb JH, Levy B, Sly WS. Biodistribution, kinetics, and efficacy of highly phosphorylated and non-phosphorylated beta-glucuronidase in the murine model of mucopolysaccharidosis VII. J Biol Chem 2001; 276:43160-5. [PMID: 11562370 DOI: 10.1074/jbc.m107778200] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Enzyme replacement therapy (ERT) has been shown to be effective at reducing the accumulation of undegraded substrates in lysosomal storage diseases. Most ERT studies have been performed with recombinant proteins that are mixtures of phosphorylated and non-phosphorylated enzyme. Because different cell types use different receptors to take up phosphorylated or non-phosphorylated enzyme, it is difficult to determine which form of enzyme contributed to the clinical response. Here we compare the uptake, distribution, and efficacy of highly phosphorylated and non-phosphorylated beta-glucuronidase (GUSB) in the MPS VII mouse. Highly phosphorylated murine GUSB was efficiently taken up by a wide range of tissues. In contrast, non-phosphorylated murine GUSB was taken up primarily by tissues of the reticuloendothelial (RE) system. Although the tissue distribution was different, the half-lives of both enzymes in any particular tissue were similar. Both preparations of enzyme were capable of preventing the accumulation of lysosomal storage in cell types they targeted. An important difference in clinical efficacy emerged in that phosphorylated GUSB was more efficient than non-phosphorylated enzyme at preventing the hearing loss associated with this disease. These data suggest that both forms of enzyme contribute to the clinical responses of ERT in MPS VII mice but that enzyme preparations containing phosphorylated GUSB are more broadly effective than non-phosphorylated enzyme.
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