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Sliem A, Siu A, Zheng J, Magana S, Alagha Z, Ghallab M, Lopez M. Cardiac Arrest as the Initial Presentation of Undiagnosed Kawasaki Disease: A Case Report and Literature Review. Cureus 2023; 15:e40855. [PMID: 37489205 PMCID: PMC10363372 DOI: 10.7759/cureus.40855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
Kawasaki Disease (KD) is a self-limited acute vasculitis that mainly affects medium-sized arteries in childhood, with the coronary arteries being one of the main targets. A well-known complication is a coronary aneurysm with myocardial ischemia. We report the case of a 29-year-old female with an insignificant past medical history who presented with sudden cardiac arrest. Labs were significant for elevated troponin, consistent with non-ST elevation myocardial infarction, given diffuse ST depression on the electrocardiogram. The patient underwent a coronary angiogram that revealed diffuse coronary artery disease with multiple ulcerations, aneurysms, and occlusions consistent with KD, despite denying prior history. Cardiac arrest may be the initial presentation of undiagnosed KD and should be considered as one of the differential diagnoses.
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Affiliation(s)
- Ashraf Sliem
- Internal Medicine, Flushing Hospital Medical Center, Flushing, USA
| | - Alfonso Siu
- Internal Medicine, Flushing Hospital Medical Center, Flushing, USA
| | - Jin Zheng
- Internal Medicine, Flushing Hospital Medical Center, Flushing, USA
| | - Sergio Magana
- Internal Medicine, Flushing Hospital Medical Center, Flushing, USA
| | - Zakaria Alagha
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, West Virginia, USA
| | - Muhammad Ghallab
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals, Queens, USA
| | - Manuel Lopez
- Cardiology, Flushing Hospital Medical Center, Flushing, USA
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Arif A, Siu A, Ahmed N, Martini A, Shripad N. LBODP015 A Pheochromocytoma Presenting With Hypertensive Emergency With A Rare Complication Of Unilateral Adrenal Hemorrhage. J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction
Adrenal hemorrhage is an uncommon finding in patients and is estimated to be present in 0.14-1.8% of postmortem examinations. Clinical diagnosis is challenging due to its non-specific presentation and most cases are diagnosed incidentally on imaging. Here we discuss the clinical presentation, diagnostic procedures, and outcome of this rare case.
Clinical Case
A 74-year-old Asian female presented to the ED with a sudden onset of severe epigastric pain with 9/10 intensity, radiating to her upper back while walking on the street. She was found in severe distress with a blood pressure of 214/80 mmHg, heart rate of 72 bpm, respiratory rate of 20 breaths/min, and oxygen saturation of 98% on room air. The physical exam was unremarkable. Laboratory findings were significant for elevated troponin of 1. 040 ng/ml (0. 00-0. 03 ng/ml), lactate 2.36mmol/L (0.70-2. 00 mmol/L), and lipase 481U/L (23-300 U/L). Chest X-ray was within normal limits. A CT angiogram of the chest and abdomen were negative for aortic dissection, however, a retroperitoneal hemorrhage measuring 6×8.5×6.5 cm was seen but an underlying adrenal gland mass could not be excluded. The patient was started on nitroglycerine drip for blood pressure control. Hemoglobin trend showed an acute drop, requiring 2 units of red blood cell transfusion. This raised concerns of worsening hemorrhage. Repeat imaging showed no significant change in the left adrenal hematoma, but arterial phase imaging still suggested active bleeding. Interventional radiology was consulted, and embolization of the left superior and inferior renal artery was done with stabilization of the patients hemodynamics. Laboratory work for secondary causes of hypertension was done. It showed elevated normetanephrines 1281 mcg/24hr (122 - 676 mcg/24hr) and total 24-hour urine metanephrines, 114 mcg/24hr (224-832 mcg/24 hr). The patients blood pressure was controlled and therefore asked for follow-up as an outpatient.
Conclusion
The majority of adrenal hemorrhages diagnosed are found incidentally, but initial symptoms of abdominal or loin pain are very important. Early acute findings may include tachycardia, hypotension, and severe abdominal pain. Subacute symptoms include flank tenderness, diarrhea, malaise, nausea, and vomiting. Unilateral adrenal hemorrhage may be the initial presentation of an underlying adrenal mass, cyst, coagulopathy or metastasis. Elevated cortisol and catecholamines released by an expanding hematoma are often seen along with elevated blood pressure, suggesting pheochromocytoma. The Hormonal analysis includes urine metanephrine and vanillylmandelic acid to rule out active pheochromocytoma. In our case, the patient had elevated urine metanephrines and normetanephrines suggestive of pheochromocytoma.
Presentation: No date and time listed
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Affiliation(s)
- Aneela Arif
- FLUSHING HOSPITAL MEDICAL CENTER , Flushing, NY , USA
| | - Alfonso Siu
- FLUSHING HOSPITAL MEDICAL CENTER , Flushing, NY , USA
| | | | - Alma Martini
- FLUSHING HOSPITAL MEDICAL CENTER , Flushing, NY , USA
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Stewart C, Siu A, Tsui C, Finer Y, Hatton B. Rapid synthesis of drug-encapsulated films by evaporation-induced self-assembly for highly-controlled drug release from biomaterial surfaces. J Mater Chem B 2022; 10:6453-6463. [PMID: 35993489 DOI: 10.1039/d1tb02121d] [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: 11/21/2022]
Abstract
Infection at the surgical site for dental implants results in failed procedures, patient pain, burdensome economic impact, and the over-prescription of prophylactic antibiotics. Mesoporous silica films as coatings for implants may provide an ideal antimicrobial drug storage and local release vector to the site of infection, however traditional drug loading techniques result in insufficient drug load and short-term release kinetics. In this work, we have applied a method to use a surfactant-antimicrobial drug octenidine dihydrochloride (OCT) as a template for mesostructured silica, to demonstrate silica-OCT composite films. The films are synthesized by evaporation induced self-assembly (EISA) and we explore the effects of synthesis parameters on porous film structure, OCT incorporation, and OCT drug release rates. Drug micelle incorporation into the silica mesostructure was highly dependent on silica precursor pre-reaction to form silica oligomers before film spin-casting. The OCT drug concentration of the synthesis solution dictated the time required for effective incorporation (without phase separation), with total loading in the film of up to 90% by mass. The OCT content in the films was found to directly determine the timescale of drug release, from 2 to 8 h for a single layer film. The total release timescale was increased by the addition of multiple layers of OCT-silica films to nearly 2 weeks. Drug release from films completely inhibited Streptococcus mutans (UA159) growth, while drug-free porous silica films showed no increase in bacterial growth over non-porous control. These OCT-silica films have a significant potential to store and release antimicrobial drugs from dental implant surfaces.
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Affiliation(s)
- C Stewart
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, Canada.
| | - A Siu
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, Canada.
| | - C Tsui
- Department of Materials Science and Engineering, University of Toronto, 184 College St, Toronto, Ontario, Canada
| | - Y Finer
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, Canada.
| | - B Hatton
- Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, Canada. .,Department of Materials Science and Engineering, University of Toronto, 184 College St, Toronto, Ontario, Canada
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Kim PJ, Olymbios M, Siu A, Wever Pinzon O, Adler E, Liang N, Swenerton R, Sternberg J, Kaur N, Ahmed E, Chen YA, Fehringer G, Demko ZP, Billings PR, Stehlik J. A novel donor-derived cell-free DNA assay for the detection of acute rejection in heart transplantation. J Heart Lung Transplant 2022; 41:919-927. [PMID: 35577713 PMCID: PMC9670834 DOI: 10.1016/j.healun.2022.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/06/2022] [Accepted: 04/04/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Endomyocardial biopsy (EMB), the reference surveillance test for acute rejection (AR) in heart transplant (HTx) recipients, is invasive, costly, and shows significant interobserver variability. Recent studies indicate that donor-derived cell-free DNA (dd-cfDNA), obtained non-invasively from blood, is associated with AR and could reduce the frequency of EMB surveillance. The aim of this study was to examine the performance characteristics of a novel test for detecting AR in adult HTx recipients. METHODS Plasma samples with contemporaneous EMBs were obtained from HTx recipients. A clinically available SNP-based massively multiplexed-PCR dd-cfDNA assay was used to measure dd-cfDNA fraction. dd-cfDNA fractions were compared with EMB-defined rejection status and test performance was assessed by constructing ROC curves and calculating accuracy measures. RESULTS A total of 811 samples from 223 patients with dd-cfDNA testing and contemporaneous EMB were eligible for the study. dd-cfDNA fraction was significantly higher in AR (median 0.58%, IQR, 0.13%-1.68%) compared to non-AR (median 0.04%, IQR, 0.01%-0.11%, pc < 0.001). ROC analysis produced an area under the curve (AUC-ROC) of 0.86 (95% CI, 0.77-0.96). Defining samples with dd-cfDNA fraction ≥0.15% as AR yielded 78.5% sensitivity (95% CI, 60.7%-96.3%) and 76.9% specificity (95% CI, 71.1%-82.7%). Positive and negative predictive values were 25.1% (95% CI, 18.8%-31.5%) and 97.3% (95% CI, 95.1%-99.5%) respectively, calculated using the cohort AR prevalence of 9.0% (95% CI, 5.3%-12.8%) with adjustment for repeat samples. CONCLUSIONS This novel dd-cfDNA test detects AR in HTx recipients with good accuracy and holds promise as a noninvasive test for AR in HTx recipients.
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Affiliation(s)
- Paul J Kim
- UC San Diego Health, San Diego, California
| | | | - Alfonso Siu
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Omar Wever Pinzon
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Eric Adler
- UC San Diego Health, San Diego, California
| | | | | | | | | | | | | | | | | | | | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
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Kim P, Olymbios M, Siu A, Pinzon O, Adler E, Liang N, Swenerton R, Sternberg J, Kaur N, Ahmed E, Butskova A, Barnes D, Fehringer G, Demko Z, Billings P, Stehlik J. Absolute Quantification of Donor Derived Cell Free DNA in Heart Transplant Patients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.270] [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: 11/25/2022] Open
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6
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Steinberg BA, Zhang M, Bensch J, Lyons A, Bunch TJ, Piccini JP, Siu A, Spertus JA, Stehlik J, Wohlfahrt P, Greene T, Hess R, Fang JC. Quantifying the Impact of Atrial Fibrillation on Heart Failure-Related Patient-Reported Outcomes in the Utah mEVAL Program. J Card Fail 2022; 28:13-20. [PMID: 34324927 PMCID: PMC8748275 DOI: 10.1016/j.cardfail.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) frequently complicates heart failure (HF), and each is associated with lower overall health-related quality of life. We aimed to quantify the incremental burden of AF on the health-related quality of life of patients with HF in clinical practice. METHODS AND RESULTS We used data from the Utah mEVAL program to analyze patient-reported outcomes (PROs) among patients with HF with and without AF. The primary outcome was the HF-specific Kansas City Cardiomyopathy Questionnaire, with generic PROs as secondary outcomes. Among 1707 patients with HF, 36% had AF (n = 616). Those with HF and AF were older (mean age 69 years vs 58 years, P < .001), more likely to have prior stroke (29% vs 17%, P < .001) and ischemic cardiomyopathy (28% vs 23%, P = .01), but had similar ejection fractions (mean 44% each, P = .6). After adjustment, and compared with HF alone, HF with AF was associated with worse Kansas City Cardiomyopathy Questionnaire scores (adjusted mean difference -3.45, 95% confidence interval [CI] -6.24 to -0.65), and worse Patient-Reported Outcomes Measurement Information System physical function scores (adjusted mean difference -1.63, 95% CI -2.59 to -0.67). The difference in visual analog scale general health was borderline (adjusted mean difference -2.01, 95% CI -4.51 to 0.49), and Patient-Reported Outcomes Measurement Information System depression scores were similar (adjusted mean difference 0.54, 95% CI -0.48 to 1.57). CONCLUSIONS AF complicates nearly one-third of HF cases, and patients with HF and AF are substantially older and sicker. After adjustment, AF was independently associated with worse disease-specific and overall health-related quality of life than HF alone. Whether maintaining sinus rhythm can improve the HF-related health status of patients with HF in clinical practice should be explored further.
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Affiliation(s)
| | - Mingyuan Zhang
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jason Bensch
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Ann Lyons
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - T Jared Bunch
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Alfonso Siu
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/UMKC, Kansas City MO
| | - Josef Stehlik
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Peter Wohlfahrt
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Tom Greene
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Rachel Hess
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - James C Fang
- University of Utah Health Sciences Center, Salt Lake City, Utah
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Nativi-Nicolau J, Siu A, Dispenzieri A, Maurer MS, Rapezzi C, Kristen AV, Garcia-Pavia P, LoRusso S, Waddington-Cruz M, Lairez O, Witteles R, Chapman D, Amass L, Grogan M. Temporal Trends of Wild-Type Transthyretin Amyloid Cardiomyopathy in the Transthyretin Amyloidosis Outcomes Survey. JACC CardioOncol 2021; 3:537-546. [PMID: 34729526 PMCID: PMC8543133 DOI: 10.1016/j.jaccao.2021.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 04/15/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Transthyretin amyloid cardiomyopathy results from the accumulation of wild-type (ATTRwt) or variant (ATTRv) transthyretin amyloid fibrils in the myocardium. THAOS (Transthyretin Amyloidosis Outcomes Survey) is a global, longitudinal, observational survey of patients with ATTRv and ATTRwt amyloidosis and asymptomatic patients with transthyretin mutations. OBJECTIVES This study explored temporal trends in ATTRwt amyloidosis diagnoses using data from THAOS. METHODS Using THAOS data from December 2007 to January 2020, the following comparisons were made according to year: ATTRwt amyloidosis diagnoses in the United States versus rest of the world, ATTRwt versus ATTRv amyloidosis with cardiac-associated mutations diagnoses, and ATTRwt amyloidosis diagnoses by tissue biopsy versus bone scintigraphy. RESULTS There were 1,069 patients with ATTRwt amyloidosis and 525 with ATTRv amyloidosis with cardiac mutations enrolled in THAOS. The median time from symptom onset to ATTRwt amyloidosis diagnosis did not change over the past 5 years (>60 months from 2015-2019). ATTRwt amyloidosis diagnoses increased from 2 in 2005 to >100 per year from 2016, with a more pronounced increase in the United States compared with the rest of the world. Diagnoses of ATTRwt amyloidosis by tissue biopsy increased yearly and peaked in 2014 before declining, whereas diagnoses by bone scintigraphy increased markedly since 2011. ATTRv amyloidosis with cardiac mutation diagnoses increased from 3 in 2005 to 37 in 2011, then plateaued. The proportion of patients with ATTRwt amyloidosis diagnosed with New York Heart Association functional class III/IV heart failure decreased from 2012 (46.4%) to 2019 (16.0%). CONCLUSIONS In the past decade, ATTRwt amyloidosis diagnoses increased worldwide. Despite the growing utilization of bone scintigraphy, patients are diagnosed several years after symptom onset. (Transthyretin Amyloidosis Outcomes Survey [THAOS]; NCT00628745).
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Affiliation(s)
- Jose Nativi-Nicolau
- University of Utah Health & Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Alfonso Siu
- University of Utah Health & Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | | | - Mathew S. Maurer
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Claudio Rapezzi
- Cardiological Centre, University of Ferrara, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Arnt V. Kristen
- Department of Cardiology, Angiology, Respiratory Medicine, Medical University of Heidelberg, Heidelberg, Germany
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain
- Universidad Francisco de Vitoria, Pozuelo de Alarcon, Madrid, Spain
| | | | - Márcia Waddington-Cruz
- Federal University of Rio de Janeiro, National Amyloidosis Referral Center, CEPARM, Rio de Janeiro, Brazil
| | - Olivier Lairez
- Department of Cardiology and Nuclear Medicine, Toulouse University Hospital, Toulouse, France
| | - Ronald Witteles
- Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Siu A. Translation and validation of the reaction to impairment and disability inventory in a chinese ccontext. Eur Psychiatry 2021. [PMCID: PMC9480186 DOI: 10.1192/j.eurpsy.2021.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionPeople with chronic illness and disabilities (CID) often need to adjust to changes in self-concept, cope with their grief from the loss of functional abilities, and to “live with the illness”. Emotional adjustment to disabilities is a major challenge in rehabilitation, but there is no validated Chinese instrument for assessing psychosocial adaptation of people with CID.ObjectivesThis study translated the Reaction to Impairment and Disability Inventory (RIDI) into Chinese and validated the Chinese version (C-RIDI), for assessing emotional adjustment in people with CID. We examined the factor structure, internal consistency, convergent validity, and criterion-related validity of the C-RIDI.MethodsWe conducted a survey of people with CID who were recruited from community-rehabilitation settings and self-help groups (n = 244). The research questionnaire collected demographic information, illness-related variables, the C-RIDI, and measures of resilience and well-being.ResultsThe C-RIDI has good content validity and no major changes to the translated items were needed for the use with Chinese population. For factor structure, we replicated the results of Livneh, Martz, & Boder (2006). The C-RIDI has two second-order factors of adaptive and non-adaptive scales, which interact with the two denial subscales. Internal consistency of the subscales is satisfactory except for the 3-item denial subscales. Correlations of the C-RIDI subscales with illness-related variables, resilience, and mental well-being are consistent with our hypotheses and provide support for the convergent and criterion-related validity of the scale.ConclusionsThe C-RIDI has satisfactory psychometric properties. The study results support its internal consistency, convergent validity, criterion-related validity, and factorial validity.DisclosureNo significant relationships.
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Siu A, Chan S, Cheung M, Mo C, Lai S, Shek D. Predictors of psychosocial adaptation and mental wellbeing among people with chronic illness and disabilities in a chinese context. Eur Psychiatry 2021. [PMCID: PMC9480170 DOI: 10.1192/j.eurpsy.2021.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction The process of adjustment to disability and illness among people with chronic illness and disabilities (CID) impacts on motivation for rehabilitation illness self-management, and psychological well-being. It involves a complex interplay of biopsychosocial factors, and was seldom examined in the Chinese context. Objectives Identify the predictors of mental well-being of people with from a set of variables including illness and social support, functional abilities, coping strategies, resilience. Examine how these factors interact in determining psychosocial adaptation and mental well-being by structural equations modelling (SEM). Methods We conducted a survey of people with CID, who were recruited from community-rehabilitation settings and self-help groups (N = 244). The research questionnaire collected basic demographic information, illness-related variables (e.g. pain, fatigue, functional limitations), and RIDI), social support, measures of resilience, coping, psychosocial ad as predictors, and mental well-being. Results Of General Linear Model (GLM) revealed that males have better adaptation than females. Resilience, social coping, & active problem solving are significant predictors of adaptation (Table 1), while age, breathing, pain, resilience, avoidance coping, are predictors of maladaptation (Table 2). A SEM was tested to examine the interaction among the predictors and outcome of adaptation and mental well-being (Figure 1), and the model fit was fair (CFI = 0.89; RMSEA = 0.09) Conclusions The results indicated that there are gender differences in adaptation. While all the hypothesized groups of variables contributed to mental well-being of people with CID. Resilience, illness variables, and some forms of coping are closely linked to adaptation and maladaptation. Disclosure No significant relationships.
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Nativi-Nicolau J, Siu A, Dispenzieri A, Maurer MS, Rapezzi C, Kristen A, Garcia-Pavia P, LoRusso S, Waddington-Cruz M, Lairez O, Witteles R, Chapman D, Rill D, Kiszko J, Amass L, Grogan M. Temporal Trends of Wild-type Attr Amyloidosis in the Transthyretin Amyloidosis Outcomes Survey. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.239] [Citation(s) in RCA: 2] [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: 11/15/2022]
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Siu A, Sierra I, Zhang M, Dranow L, Hong J, Waldron J, Caballero K, Greene T, Kovacsovics T, Stehlik J, Nativi-Nicolau J. Patient Reported Outcomes In Amyloidosis Cardiomyopathy. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.337] [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: 11/29/2022]
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12
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Ornstein K, Garrido M, Siu A. IMPACT OF NEIGHBORHOOD RESOURCES ON HOMEBOUND STATUS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2852] [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)
| | - M Garrido
- Icahn School of Medicine at Mount Sinai
| | - A Siu
- Icahn School of Medicine at Mount Sinai
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Leff B, De Cherrie L, Wajnberg A, Federman A, Soones T, Brody A, Siu A. THE HOSPITAL AT HOME/MACT ‘PLATFORM’ MODEL—A SPECTRUM OF FACILITY-LEVEL CARE PROVIDED AT HOME. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4527] [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: 11/13/2022] Open
Affiliation(s)
- B.A. Leff
- Johns Hopkins University School of Medicine, Baltimore, Maryland,
| | - L. De Cherrie
- Icahn School of Medicine, Mount Sinai, New York, New York,
| | - A. Wajnberg
- Icahn School of Medicine, Mount Sinai, New York, New York,
| | - A. Federman
- Icahn School of Medicine, Mount Sinai, New York, New York,
| | - T. Soones
- Icahn School of Medicine, Mount Sinai, New York, New York,
| | - A. Brody
- New York University, New York, New York
| | - A. Siu
- Icahn School of Medicine, Mount Sinai, New York, New York,
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Ornstein K, Soones T, Siu A. HOW DO ECONOMIC FACTORS DRIVE HOMEBOUND STATUS? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.184] [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: 11/13/2022] Open
Affiliation(s)
- K. Ornstein
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - T. Soones
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - A. Siu
- Icahn School of Medicine at Mount Sinai, New York, New York
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Ganz D, Siu A, Magaziner J, Travison T, Gill T, Latham N. STRIDE: ASCERTAINING SERIOUS FALL-RELATED INJURIES IN A PRAGMATIC TRIAL OF FALL PREVENTION. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3659] [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: 11/13/2022] Open
Affiliation(s)
- D. Ganz
- University of California, Los Angeles, Los Angeles, California,
| | - A. Siu
- Mount Sinai Hospital, New York, New York,
| | | | - T. Travison
- Harvard University, Cambridge, Massachusetts,
| | - T.M. Gill
- Yale University, New Haven, Connecticut,
| | - N. Latham
- Boston University, Boston, Massachusetts
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Koti M, Siu A, Clément I, Bidarimath M, Turashvili G, Edwards A, Rahimi K, Mes-Masson AM, Squire JA. A distinct pre-existing inflammatory tumour microenvironment is associated with chemotherapy resistance in high-grade serous epithelial ovarian cancer. Br J Cancer 2016; 113:1746. [PMID: 26695556 PMCID: PMC4702007 DOI: 10.1038/bjc.2015.459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Koti M, Siu A, Clément I, Bidarimath M, Turashvili G, Edwards A, Rahimi K, Mes-Masson AM, Masson AMM, Squire JA. A distinct pre-existing inflammatory tumour microenvironment is associated with chemotherapy resistance in high-grade serous epithelial ovarian cancer. Br J Cancer 2015; 112:1215-22. [PMID: 25826225 PMCID: PMC4385963 DOI: 10.1038/bjc.2015.81] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/23/2015] [Accepted: 01/29/2015] [Indexed: 12/15/2022] Open
Abstract
Background: Chemotherapy resistance is a major determinant of poor overall survival rates in high-grade serous ovarian cancer (HGSC). We have previously shown that gene expression alterations affecting the NF-κB pathway characterise chemotherapy resistance in HGSC, suggesting that the regulation of an immune response may be associated with this phenotype. Methods: Given that intrinsic drug resistance pre-exists and is governed by both tumour and host factors, the current study was performed to examine the cross-talk between tumour inflammatory microenvironment and cancer cells, and their roles in mediating differential chemotherapy response in HGSC patients. Expression profiling of a panel of 184 inflammation-related genes was performed in 15 chemoresistant and 19 chemosensitive HGSC tumours using the NanoString nCounter platform. Results: A total of 11 significantly differentially expressed genes were found to distinguish the two groups. As STAT1 was the most significantly differentially expressed gene (P=0.003), we validated the expression of STAT1 protein by immunohistochemistry using an independent cohort of 183 (52 resistant and 131 sensitive) HGSC cases on a primary tumour tissue microarray. Relative expression levels were subjected to Kaplan–Meier survival analysis and Cox proportional hazard regression models. Conclusions: This study confirms that higher STAT1 expression is significantly associated with increased progression-free survival and that this protein together with other mediators of tumour–host microenvironment can be applied as a novel response predictive biomarker in HGSC. Furthermore, an overall underactive immune microenvironment suggests that the pre-existing state of the tumour immune microenvironment could determine response to chemotherapy in HGSC.
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Affiliation(s)
- M Koti
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - A Siu
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - I Clément
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada, Institut du Cancer de Montréal, Montreal, QC H2X 0B9, Canada
| | - M Bidarimath
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - G Turashvili
- Department of Pathology and Molecular Medicine, Kingston General Hospital, Kingston, ON K7L3N6, Canada
| | - A Edwards
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - K Rahimi
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3C 3J7, Canada
| | | | - A-M M Masson
- 1] Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada, Institut du Cancer de Montréal, Montreal, QC H2X 0B9, Canada [2] Department of Medicine, Universite de Montreal, Montreal, QC H3C 3J7, Canada
| | - J A Squire
- Departments of Genetics and Pathology, Faculdade de Medicina de Ribeirão Preto USP, Av. Bandeirantes, 3900 Ribeirão Preto, SP Brazil
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Panditharatna E, Kambhampati M, Ho CY, Gordish-Dressman H, Siu A, Hwang E, Stampar M, Packer R, Nazarian J. GE-24 * CHARACTERIZING INTRATUMOR HETEROGENEITY AND TUMOR EXTENSION IN PEDIATRIC DIFFUSE INTRINSIC PONTINE GLIOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou256.23] [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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Classen CF, William D, Linnebacher M, Farhod A, Kedr W, Elsabe B, Fadel S, Van Gool S, De Vleeschouwer S, Koks C, Garg A, Ehrhardt M, Riva M, De Vleeschouwer S, Agostinis P, Graf N, Van Gool S, Yao TW, Yoshida Y, Zhang J, Ozawa T, James D, Nicolaides T, Kebudi R, Cakir FB, Gorgun O, Agaoglu FY, Darendeliler E, Van Gool S, De Vleeschouwer S, Al-Kofide A, Al-Shail E, Khafaga Y, Al-Hindi H, Dababo M, Haq AU, Anas M, Barria MG, Siddiqui K, Hassounah M, Ayas M, van Zanten SV, Jansen M, van Vuurden D, Huisman M, Vugts D, Hoekstra O, van Dongen G, Kaspers G, Cockle J, Ilett E, Scott K, Bruning-Richardson A, Picton S, Short S, Melcher A, Benesch M, Warmuth-Metz M, von Bueren AO, Hoffmann M, Pietsch T, Kortmann RD, Eyrich M, Graf N, Rutkowski S, Fruhwald MC, Faber J, Kramm C, Porkholm M, Valanne L, Lonnqvist T, Holm S, Lannering B, Riikonen P, Wojcik D, Sehested A, Clausen N, Harila-Saari A, Schomerus E, Thorarinsdottir HK, Lahteenmaki P, Arola M, Thomassen H, Saarinen-Pihkala UM, Kivivuori SM, Buczkowicz P, Hoeman C, Rakopoulos P, Pajovic S, Morrison A, Bouffet E, Bartels U, Becher O, Hawkins C, Gould TWA, Rahman CV, Smith SJ, Barrett DA, Shakesheff KM, Grundy RG, Rahman R, Barua N, Cronin D, Gill S, Lowisl S, Hochart A, Maurage CA, Rocourt N, Vinchon M, Kerdraon O, Escande F, Grill J, Pick VK, Leblond P, Burzynski G, Janicki T, Burzynski S, Marszalek A, Ramani N, Zaky W, Kannan G, Morani A, Sandberg D, Ketonen L, Maher O, Corrales-Medina F, Meador H, Khatua S, Brassesco M, Delsin L, Roberto G, Silva C, Ana L, Rego E, Scrideli C, Umezawa K, Tone L, Kim SJ, Kim CY, Kim IA, Han JH, Choi BS, Ahn HS, Choi HS, Haque F, Rahman R, Layfield R, Grundy R, Gandola L, Pecori E, Biassoni V, Schiavello E, Chiruzzi C, Spreafico F, Modena P, Bach F, Pignoli E, Massimino M, Drogosiewicz M, Dembowska-Baginska B, Jurkiewicz E, Filipek I, Perek-Polnik M, Swieszkowska E, Perek D, Bender S, Jones DT, Warnatz HJ, Hutter B, Zichner T, Gronych J, Korshunov A, Eils R, Korbel JO, Yaspo ML, Lichter P, Pfister SM, Yadavilli S, Becher OJ, Kambhampati M, Packer RJ, Nazarian J, Lechon FC, Fowkes L, Khabra K, Martin-Retortillo LM, Marshall LV, Vaidya S, Koh DM, Leach MO, Pearson AD, Zacharoulis S, Lechon FC, Fowkes L, Khabra K, Martin-Retortillo LM, Marshall LV, Schrey D, Barone G, Vaidya S, Koh DM, Pearson AD, Zacharoulis S, Panditharatna E, Stampar M, Siu A, Gordish-Dressman H, Devaney J, Kambhampati M, Hwang EI, Packer RJ, Nazarian J, Chung AH, Mittapalli RK, Elmquist WF, Becher OJ, Castel D, Debily MA, Philippe C, Truffaux N, Taylor K, Calmon R, Boddaert N, Le Dret L, Saulnier P, Lacroix L, Mackay A, Jones C, Puget S, Sainte-Rose C, Blauwblomme T, Varlet P, Grill J, Entz-Werle N, Maugard C, Bougeard G, Nguyen A, Chenard MP, Schneider A, Gaub MP, Tsoli M, Vanniasinghe A, Luk P, Dilda P, Haber M, Hogg P, Ziegler D, Simon S, Tsoli M, Vanniasinghe A, Monje M, Gurova K, Gudkov A, Haber M, Ziegler D, Zapotocky M, Churackova M, Malinova B, Zamecnik J, Kyncl M, Tichy M, Puchmajerova A, Stary J, Sumerauer D, Boult J, Vinci M, Taylor K, Perryman L, Box G, Jury A, Popov S, Ingram W, Monje M, Eccles S, Jones C, Robinson S, Emir S, Demir HA, Bayram C, Cetindag F, Kabacam GB, Fettah A, Boult J, Li J, Vinci M, Jury A, Popov S, Jamin Y, Cummings C, Eccles S, Bamber J, Sinkus R, Jones C, Robinson S, Nandhabalan M, Bjerke L, Vinci M, Burford A, Ingram W, Mackay A, von Bueren A, Baudis M, Clarke P, Collins I, Workman P, Jones C, Taylor K, Mackay A, Vinci M, Popov S, Ingram W, Entz-Werle N, Monje M, Olaciregui N, Mora J, Carcaboso A, Bullock A, Jones C, Vinci M, Mackay A, Burford A, Taylor K, Popov S, Ingram W, Monje M, Alonso M, Olaciregui N, de Torres C, Cruz O, Mora J, Carcaboso A, Jones C, Filipek I, Drogosiewicz M, Perek-Polnik M, Swieszkowska E, Dembowska-Baginska B, Jurkiewicz E, Perek D, Nguyen A, Pencreach E, Mackay A, Moussalieh FM, Guenot D, Namer I, Chenard MP, Jones C, Entz-Werle N, Pollack I, Jakacki R, Butterfield L, Hamilton R, Panigrahy A, Potter D, Connelly A, Dibridge S, Whiteside T, Okada H, Ahsan S, Raabe E, Haffner M, Warren K, Quezado M, Ballester L, Nazarian J, Eberhart C, Rodriguez F, Ramachandran C, Nair S, Quirrin KW, Khatib Z, Escalon E, Melnick S, Classen CF, Hofmann M, Schmid I, Simon T, Maass E, Russo A, Fleischhack G, Becker M, Hauch H, Sander A, Kramm C, Grasso C, Truffaux N, Berlow N, Liu L, Debily MA, Davis L, Huang E, Woo P, Tang Y, Ponnuswami A, Chen S, Huang Y, Hutt-Cabezas M, Warren K, Dret L, Meltzer P, Mao H, Quezado M, van Vuurden D, Abraham J, Fouladi M, Svalina MN, Wang N, Hawkins C, Raabe E, Hulleman E, Li XN, Keller C, Spellman PT, Pal R, Grill J, Monje M, Jansen MHA, Sewing ACP, Lagerweij T, Vuchts DJ, van Vuurden DG, Caretti V, Wesseling P, Kaspers GJL, Hulleman E, Cohen K, Raabe E, Pearl M, Kogiso M, Zhang L, Qi L, Lindsay H, Lin F, Berg S, Li XN, Muscal J, Amayiri N, Tabori U, Campbel B, Bakry D, Aronson M, Durno C, Gallinger S, Malkin D, Qaddumi I, Musharbash A, Swaidan M, Bouffet E, Hawkins C, Al-Hussaini M, Rakopoulos P, Shandilya S, McCully C, Murphy R, Akshintala S, Cole D, Macallister RP, Cruz R, Widemann B, Warren K, Salloum R, Smith A, Glaunert M, Ramkissoon A, Peterson S, Baker S, Chow L, Sandgren J, Pfeifer S, Popova S, Alafuzoff I, de Stahl TD, Pietschmann S, Kerber MJ, Zwiener I, Henke G, Kortmann RD, Muller K, von Bueren A, Sieow NYF, Hoe RHM, Tan AM, Chan MY, Soh SY, Hawkins C, Burrell K, Chornenkyy Y, Remke M, Golbourn B, Buczkowicz P, Barzczyk M, Taylor M, Rutka J, Dirks P, Zadeh G, Agnihotri S, Hashizume R, Ihara Y, Andor N, Chen X, Lerner R, Huang X, Tom M, Solomon D, Mueller S, Petritsch C, Zhang Z, Gupta N, Waldman T, James D, Dujua A, Co J, Hernandez F, Doromal D, Hegde M, Wakefield A, Brawley V, Grada Z, Byrd T, Chow K, Krebs S, Heslop H, Gottschalk S, Yvon E, Ahmed N, Truffaux N, Philippe C, Cornilleau G, Paulsson J, Andreiuolo F, Guerrini-Rousseau L, Puget S, Geoerger B, Vassal G, Ostman A, Grill J, Parsons DW, Lin F, Trevino LR, Gao F, Shen X, Hampton O, Lindsay H, Kosigo M, Qi L, Baxter PA, Su JM, Chintagumpala M, Dauser R, Adesina A, Plon SE, Li XN, Wheeler DA, Lau CC, Pietsch T, Gielen G, Muehlen AZ, Kwiecien R, Wolff J, Kramm C, Lulla RR, Laskowski J, Goldman S, Gopalakrishnan V, Fangusaro J, Mackay A, Taylor K, Vinci M, Jones C, Kieran M, Fontebasso A, Papillon-Cavanagh S, Schwartzentruber J, Nikbakht H, Gerges N, Fiset PO, Bechet D, Faury D, De Jay N, Ramkissoon L, Corcoran A, Jones D, Sturm D, Johann P, Tomita T, Goldman S, Nagib M, Bendel A, Goumnerova L, Bowers DC, Leonard JR, Rubin JB, Alden T, DiPatri A, Browd S, Leary S, Jallo G, Cohen K, Prados MD, Banerjee A, Carret AS, Ellezam B, Crevier L, Klekner A, Bognar L, Hauser P, Garami M, Myseros J, Dong Z, Siegel PM, Gump W, Ayyanar K, Ragheb J, Khatib Z, Krieger M, Kiehna E, Robison N, Harter D, Gardner S, Handler M, Foreman N, Brahma B, MacDonald T, Malkin H, Chi S, Manley P, Bandopadhayay P, Greenspan L, Ligon A, Albrecht S, Pfister SM, Ligon KL, Majewski J, Gupta N, Jabado N, Hoeman C, Cordero F, Halvorson K, Hawkins C, Becher O, Taylor I, Hutt M, Weingart M, Price A, Nazarian J, Eberhart C, Raabe E, Kantar M, Onen S, Kamer S, Turhan T, Kitis O, Ertan Y, Cetingul N, Anacak Y, Akalin T, Ersahin Y, Mason G, Nazarian J, Ho C, Devaney J, Stampar M, Kambhampati M, Crozier F, Vezina G, Packer R, Hwang E, Gilheeney S, Millard N, DeBraganca K, Khakoo Y, Kramer K, Wolden S, Donzelli M, Fischer C, Petriccione M, Dunkel I, Afzal S, Carret AS, Fleming A, Larouche V, Zelcer S, Johnston DL, Kostova M, Mpofu C, Decarie JC, Strother D, Lafay-Cousin L, Eisenstat D, Fryer C, Hukin J, Bartels U, Bouffet E, Hsu M, Lasky J, Moore T, Liau L, Davidson T, Prins R, Fouladi M, Bartels U, Warren K, Hassal T, Baugh J, Kirkendall J, Doughman R, Leach J, Jones B, Miles L, Hawkins C, Bouffet E, Hargrave D, Grill J, Jones C, Jacques T, Savage S, Goldman S, Leary S, Packer R, Saunders D, Wesseling P, Varlet P, van Vuurden D, Wallace R, Flutter B, Morgenestern D, Hargrave D, Blanco E, Howe K, Lowdell M, Samuel E, Michalski A, Anderson J, Arakawa Y, Umeda K, Watanabe KI, Mizowaki T, Hiraoka M, Hiramatsu H, Adachi S, Kunieda T, Takagi Y, Miyamoto S, Venneti S, Santi M, Felicella MM, Sullivan LM, Dolgalev I, Martinez D, Perry A, Lewis PW, Allis DC, Thompson CB, Judkins AR. HIGH GRADE GLIOMAS AND DIPG. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yang FH, Zhang B, Zhou DJ, Bie L, Tom MW, Drummond DC, Nicolaides T, Mueller S, Banerjee A, Park JW, Prados MD, James DC, Gupta N, Hashizume R, Strohbehn GW, Zhou J, Fu M, Patel TR, Piepmeier JM, Saltzman WM, Xie Q, Johnson J, Bradley R, Ascierto ML, Kang L, Koeman J, Marincola FM, Briggs M, Tanner K, Vande Woude GF, Tanaka S, Klofas LK, Wakimoto H, Borger DR, Iafrate AJ, Batchelor TT, Chi AS, Madhankumar AB, Slagle-Webb B, Rizk E, Harbaugh K, Connor JR, Sarkar G, Curran GL, Jenkins RB, Kurozumi K, Ichikawa T, Onishi M, Fujii K, Ishida J, Shimazu Y, Date I, Ebsworth K, Walters MJ, Ertl LS, Wang Y, Berahovich RD, Zhang P, Powers JP, Liu SC, Al Omran R, Sullivan TJ, Jaen JC, Brown M, Schall TJ, Yusuke N, Shimizu S, Shishido-Hara Y, Shiokawa Y, Nagane M, Wang J, Sai K, Chen FR, Chen ZP, Shi Z, Zhang J, Zhang K, Han L, Chen L, Qian X, Zhang A, Wang G, Jia Z, Pu P, Kang C, Kong LY, Doucette TA, Ferguson SD, Hachem J, Yang Y, Wei J, Priebe W, Fuller GN, Qiao W, Rao G, Heimberger AB, Chen PY, Ozawa T, Drummond D, Santos R, Torre JD, Ng C, Lepe EL, Butowski N, Prados M, Bankiewicz K, James CD, Cheng Z, Gong Y, Ma Y, Muller-Knapp S, Knapp S, Wang J, Fujii K, Kurozumi K, Ichikawa T, Onishi M, Shimazu Y, Ishida J, Antonio Chiocca E, Kaur B, Date I, Yu JS, Judkowski V, Bunying A, Ji J, Li Z, Bender J, Pinilla C, Srinivasan V, Dombovy-Johnson M, Carson-Walter E, Walter K, Xu Z, Popp B, Schlesinger D, Gray L, Sheehan J, Keir ST, Friedman HS, Bigner DD, Kut C, Tyler B, McVeigh E, Li X, Herzka D, Grossman S, Lasky JL, Wang Y, Panosyan E, Meisen WH, Hardcastle J, Wojton J, Wohleb E, Alvarez-Breckenridge C, Nowicki M, Godbout J, Kaur B, Lee SY, Slagle-Webb B, Sheehan JM, Connor JR, Yin S, Kaluz S, Devi SN, de Noronha R, Nicolaou KC, Van Meir EG, Lachowicz JE, Demeule M, Che C, Tripathy S, Jarvis S, Currie JC, Regina A, Nguyen T, Castaigne JP, Zielinska-Chomej K, Mohanty C, Viktorsson K, Lewensohn R, Driscoll JJ, Alsidawi S, Warnick RE, Rixe O, deCarvalho AC, Irtenkauf S, Hasselbach L, Xin H, Mikkelsen T, Sherman JH, Siu A, Volotskova O, Keidar M, Gibo DM, Dickinson P, Robertson J, Rossmeisl J, Debinski W, Nair S, Schmittling R, Boczkowski D, Archer G, Bigner DD, Sampson JH, Mitchell DA, Miller IS, Didier S, Murray DW, Issaivanan M, Coniglio SJ, Segall JE, Al-Abed Y, Symons M, Fotovati A, Hu K, Wakimoto H, Triscott J, Bacha J, Brown DM, Dunn SE, Daniels DJ, Peterson TE, Dietz AB, Knutson GJ, Parney IF, Diaz RJ, Golbourn B, Picard D, Smith C, Huang A, Rutka J, Saito N, Fu J, Yao J, Wang S, Koul D, Yung WKA, Fu J, Koul D, Yao J, Wang S, Yuan Y, Sulman EP, Colman H, Lang FF, Yung WKA, Slat EA, Herzog ED, Rubin JB, Brown M, Carminucci AS, Amendolara B, Leung R, Lei L, Canoll P, Bruce JN, Wojton JA, Chu Z, Kwon CH, Chow LM, Palascak M, Franco R, Bourdeau T, Thornton S, Qi X, Kaur B, Kitange GJ, Mladek AC, Su D, Carlson BL, Schroeder MA, Pokorny JL, Bakken KK, Gupta SK, Decker PA, Wu W, Sarkaria JN, Colman H, Oddou MP, Mollard A, Call LT, Vakayalapati H, Warner SL, Sharma S, Bearss DJ, Chen TC, Cho H, Wang W, Hofman FM, Flores CT, Snyder D, Sanchez-Perez L, Pham C, Friedman H, Bigner DD, Sampson JH, Mitchell DA, Woolf E, Abdelwahab MG, Turner G, Preul MC, Lynch A, Rho JM, Scheck AC, Salphati L, Heffron TP, Alicke B, Barck K, Carano RA, Cheong J, Greve J, Lee LB, Nishimura M, Pang J, Plise EG, Reslan HB, Zhang X, GOuld SG, Olivero AG, Phillips HS, Zadeh G, Jalali S, Voce D, Wei Z, Shijun K, Nikolai K, Josh W, Clayton C, Bakhtiar Y, Alkins R, Burgess A, Ganguly M, Wels W, Hynynen K, Li YM, Jun H, Daniel V, Walter HA, Nakashima H, Nguyen TT, Shalkh I, Goins WF, Chiocca EA, Pyko IV, Nakada M, Furuyama N, Lei T, Hayashi Y, Kawakami K, Minamoto T, Fedulau AS, Hamada JI. LAB-EXPERIMENTAL (PRE-CLINICAL) THERAPEUTICS AND PHARMACOLOGY. Neuro Oncol 2012; 14:vi25-vi37. [PMCID: PMC3488776 DOI: 10.1093/neuonc/nos222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
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Boockvar KS, Livote EE, Goldstein N, Nebeker JR, Siu A, Fried T. Electronic health records and adverse drug events after patient transfer. Qual Saf Health Care 2010; 19:e16. [PMID: 20724395 DOI: 10.1136/qshc.2009.033050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Our objective was to examine the frequencies of medication error and adverse drug events (ADEs) at the time of patient transfer in a system with an electronic health record (EHR) as compared with a system without an EHR. It was hypothesised that the frequencies of these events would be lower in the EHR system because of better information exchange across sites of care. METHODS 469 patients transferred between seven nursing homes and three hospitals in New York and Connecticut between 1999 and 2005 were followed retrospectively. Two groups of patients were compared: US Veterans Affairs (VA) patients, with an EHR, and non-VA patients, without an EHR, on the following measures: (1) medication prescribing discrepancies at nursing home/hospital transfer, (2) high-risk medication discrepancies and (3) ADEs caused by medication discrepancies according to structured medical record review by pairs of physician and pharmacist raters. RESULTS The overall incidence of ADE caused by medication discrepancies was 0.20 per hospitalisation episode. After controlling for demographic and clinical covariates, there were no significant differences between VA and non-VA groups in medication discrepancies (mean difference 0.02; 95% CI -0.81 to 0.85), high-risk medication discrepancies (-0.18; 95%CI -0.22 to 0.58) or occurrence of an ADE caused by a medication discrepancy (OR 0.96; 95% CI 0.18 to 5.01). CONCLUSIONS There was no difference, with and without an EHR, in the occurrence of medication discrepancies or ADEs caused by medication discrepancies at the time of transfer between sites of care. Reducing such problems may require specialised computer tools to facilitate medication review.
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Affiliation(s)
- K S Boockvar
- Geriatric Research, Education, and Clinical Center, James J Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA.
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Provencio JJ, Fu X, Siu A, Rasmussen PA, Hazen SL, Ransohoff RM. CSF neutrophils are implicated in the development of vasospasm in subarachnoid hemorrhage. Neurocrit Care 2010; 12:244-51. [PMID: 19967568 DOI: 10.1007/s12028-009-9308-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [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: 11/26/2022]
Abstract
BACKGROUND Cerebral vasospasm is a significant cause of morbidity in patients after aneurysmal subarachnoid hemorrhage (aSAH). There are few effective treatments. The search for new treatments has focused predominantly on dilating cerebral blood vessels. Growing evidence supports a role for inflammation in its pathogenesis but no potential target for intervention has emerged. METHODS CSF and clinical information from patients with aSAH were collected. Additionally, tyrosine modifications by stable isotope dilution HPLC with online tandem mass spectrometry were quantified in CSF samples. RESULTS We report an association between neutrophil accumulation in the cerebrospinal fluid of patients with aSAH and the development of vasospasm. In particular, CSF neutrophil content of >62% on the third day after aSAH is an independent predictor of the later development of vasospasm (OR 6.8, 95% CI 2.0-23.3, P = 0.002). Further, activity of myeloperoxidase and NADPH oxidase is elevated in aSAH suggesting a role for modification of CSF proteins by reactive oxidant species. CONCLUSIONS Neutrophil percentage is an independent predictor of vasospasm in aSAH patients, days prior to its onset suggesting a role of neutrophils in vasospasm. The activity of neutrophil enzymes is also increased suggesting a mechanism for blood vessel damage. Inflammation mediated by neutrophils is a potential target for therapies in vasospasm. More study is necessary to determine the mechanism by which neutrophils damage cerebral blood vessels.
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Affiliation(s)
- J J Provencio
- NB3, Neuroinflammation Research Center, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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Boockvar KS, Liu S, Goldstein N, Nebeker J, Siu A, Fried T. Prescribing discrepancies likely to cause adverse drug events after patient transfer. Qual Saf Health Care 2009; 18:32-6. [PMID: 19204129 DOI: 10.1136/qshc.2007.025957] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Medication-prescribing discrepancies are used as a quality measure for patients transferred between sites of care. The objective of this study was to quantify the rate of adverse drug events (ADEs) caused by prescribing discrepancies and the discrimination of an index of high-risk transition drug prescribing. METHODS We examined medical records of patients transferred between seven nursing homes and three hospitals between 1999 and 2005 in New York and Connecticut for transfer-associated prescribing discrepancies. ADEs caused by discrepancies were determined by two clinician raters. We calculated the fraction of medication discrepancies that caused ADEs in each of 22 drug classes by calculating positive predictive values (PPVs). We calculated the discrimination of a count of high-risk drug discrepancies, selected from published lists of high-risk medications and using observed PPVs. RESULTS 208 patients were hospitalised 304 times. Overall, 65 of 1350 prescribing discrepancies caused ADEs, for a PPV of 0.048 (95% CI 0.037 to 0.061). PPVs by drug class ranged from 0 to 0.28. Drug classes with the highest PPVs were opioid analgesics, metronidazole, and non-opioid analgesics. Patients with 0, 1-2 and >/=3 high-risk discrepancies had a 13%, 23% and 47% chance of experiencing a discrepancy-related ADE, respectively. CONCLUSIONS Discrepancies in certain drug classes more often caused ADEs than other types of discrepancies in hospitalised nursing-home patients. Information about ADEs caused by medication discrepancies can be used to enhance measurement of care quality, identify high-risk patients and inform the development of decision-support tools at the time of patient transfer.
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Affiliation(s)
- K S Boockvar
- Geriatric Research, Education, and Clinical Center, James J Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA.
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Abstract
OBJECTIVES To develop and validate an instrument to assess medical students' attitudes toward home care. DESIGN Survey administration before and following participation in a home care training program. SETTING Five medical schools in the United States. PARTICIPANTS 326 third and fourth year medical students. MEASUREMENTS Factor analysis was performed on all posttests. Domains were tested for internal reliability (Chronbach's alpha). Interdomain correlation was tested. One-way analysis of variance (ANOVA) was used to determine whether the results for each domain differed among the five programs. RESULTS Using exploratory factor analysis, the original 20-item survey was revised to yield a 14-item survey consisting of four domains (general attitudes, home-based therapies, home care training, and time and reimbursement). Domain intra-item reliability ranged from 0.60 to 0.82. Interdomain correlations were found to be significant with the exception of one comparison (time and reimbursement and home care training). One-way ANOVA showed significant differences between the training programs for two of the four domains (home-based therapies and home care training). For a third domain, time and reimbursement, there was a trend toward differences across the schools (P = 0.06). CONCLUSION The instrument described in this paper is a reliable and valid instrument for assessing the impact of home care training on medical student attitudes across a series of important domains.
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Affiliation(s)
- J Boal
- Department of Medicine, The Mount Sinai School of Medicine, New York, New York 10029, USA
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Barnett SH, Kaiser S, Morgan LK, Sullivant J, Siu A, Rose D, Rico M, Smith L, Schechter C, Miller M, Stagnaro-Green A. An integrated program for evidence-based medicine in medical school. Mt Sinai J Med 2000; 67:163-8. [PMID: 10747374] [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: 02/16/2023]
Abstract
To provide optimal care for their patients, clinicians must be able to locate and interpret the most current literature. Teaching the necessary skills to medical students is essential, if we wish to train clinicians to be able to keep up with the expansion of biomedical knowledge for their entire working lives. In this paper, we describe our school's four-year curriculum in evidence-based medicine and the performance of three senior classes on the summative evaluation exercise devised to measure the program's success.
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Affiliation(s)
- S H Barnett
- Department of Medical Education, Mount Sinai School of Medicine, Box 1512, One East 100th Street, New York, NY 10029, USA
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Timmermans C, Rodriguez LM, Ayers GM, Siu A, Smeets J, Barenbrug P, Wellens HJ. Design and preliminary data of the Metrix Atrioverter expanded indication trial. J Interv Card Electrophysiol 2000; 4 Suppl 1:197-9. [PMID: 10590508 DOI: 10.1023/a:1009871724481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Metrixtrade mark Atrioverter Expanded Indication Trial evaluates the safety and efficacy of an implantable atrial defibrillator in patients with symptomatic, recurrent and drug refractory atrial fibrillation who also have structural heart disease. In this ongoing multicenter study, all patients are anticoagulated and concomitant antiarrhythmic drug treatment is left to the preference of the physician. Holter monitoring is performed prior to enrollment in the study. Spontaneous episodes of atrial fibrillation (AF) are treated under physician observation and when patients are ambulatory, the device is programmed in a monitoring mode. The atrial defibrillation threshold is measured at implantation and at 3, 6 and 12 months thereafter. The performance of the AF detection and R-wave synchronization algorithm is assessed at implantation, at regular follow-up intervals, and each time the patient visits the hospital for treatment of a spontaneous episode of AF. An echocardiogram is performed prior to implantation, at 3 and 6 month follow-up and for patients with an implanted heart valve, after 20 and 50 atrial defibrillation shocks have been delivered. The study started on October 1997 and will end after the last patient enrolled completes his/her six-month post-implantation follow-up, unless a safety issue arises. As of September 1998, 6 patients (2 patients with tachycardia induced cardiomyopathy, 1 patient with a mitral valve prosthesis, 2 patients with hypertrophic cardiomyopathy and 1 patient with congenital heart disease) have been enrolled in the study. Over 350 shocks have been delivered for atrial defibrillation testing or termination of spontaneous AF episodes. There have been no reported cases of ventricular proarrhythmia or inaccurately synchronized shocks and no complications of device therapy in this population.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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Ridgeway AG, Petropoulos H, Siu A, Ball JK, Skerjanc IS. Cloning, tissue distribution, subcellular localization and overexpression of murine histidine-rich Ca2+ binding protein. FEBS Lett 1999; 456:399-402. [PMID: 10462052 DOI: 10.1016/s0014-5793(99)00993-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 11/23/2022]
Abstract
The histidine-rich Ca2+ binding protein (HRC) resides in the sarcoplasmic reticulum of muscle and binds Ca2+. Since Ca2+ concentrations can regulate gene expression via calcineurin, the mouse homologue of HRC (mHRC) was isolated and characterized. mHRC was detected in muscle progenitor cells, in primary clonal thymic tumors and a tumor cell line, suggesting a broader role for mHRC than in Ca2+ storage during muscle contraction. mHRC was present in the perinuclear region of myoblasts. To examine if it can regulate gene expression, mHRC was overexpressed in cells differentiating into cardiac and skeletal muscle. mHRC had no effect on cardiogenesis or myogenesis. Therefore, if mHRC plays a role in the regulation of gene expression during cellular differentiation, it does not appear to be either rate-limiting or inhibitory.
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Affiliation(s)
- A G Ridgeway
- Department of Biochemistry, University of Western Ontario, London, Canada
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Chui SSY, Siu A, Williams ID. Sodium copper(II) trimesate, [NaCu{C6H3(COO)3}(H2O)4].2H2O, a double-sheet coordination polymer with bridging aqua ligands. Acta Crystallogr C 1999. [DOI: 10.1107/s0108270198010944] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lee RJ, Wong M, Siu A, Namekawa-Wong M, Epstein LM, Fitzpatrick AP, Grogin HR, Scheinman MM, Lesh MD. Long-term results of electrophysiologically guided sotalol therapy for life-threatening ventricular arrhythmias. Am Heart J 1996; 132:973-8. [PMID: 8892770 DOI: 10.1016/s0002-8703(96)90008-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The efficacy and safety of sotalol therapy for ventricular arrhythmias was evaluated in 133 patients with drug-refractory ventricular arrhythmias. All patients had baseline electrophysiologic studies before and after oral sotalol therapy. Sixty-six patients were discharged home, treated with sotalol (52 patients without inducible ventricular tachycardia or fibrillation and 14 patients with hemodynamically stable inducible ventricular tachycardia). The mean follow-up period was 41 +/- 27 months for the 14 patients with hemodynamically stable ventricular tachycardia. Sotalol was effective in 8 of these 14 patients. Recurrent nonlethal ventricular tachycardia occurred in 3 patients; 2 patients had sudden death; and 1 patient had adverse side effects. The 52 patients without inducible ventricular tachycardia were followed up for a mean period of 36 +/- 30 months. Thirty-five of 52 patients were successfully treated. Two patients had recurrent ventricular tachycardia; both of these episodes of ventricular tachycardia occurred within the first year. Four patients had sudden cardiac death; three of these deaths occurred within the first month, and the last episode of sudden death occurred after 8 years of sotalol therapy. The actuarial incidence of sotalol efficacy was 76% at 1 year, 72% at 2 years, 64% at 4 years, and 52% at 5 years. Approximately 46% of patients receiving long-term sotalol treatment reported side effects. Side effects severe enough to warrant withdrawal of sotalol occurred in 7 (11%) patients. The results of our study suggest that sotalol is effective for selected patients with drug refractory ventricular arrhythmias. Although the incidence of side effects are high, patients appear to tolerate long-term sotalol therapy well.
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Affiliation(s)
- R J Lee
- Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco 94143-1354, USA
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Fitzpatrick AP, Kourouyan HD, Siu A, Lee RJ, Lesh MD, Epstein LM, Griffin JC, Scheinman MM. Quality of life and outcomes after radiofrequency His-bundle catheter ablation and permanent pacemaker implantation: impact of treatment in paroxysmal and established atrial fibrillation. Am Heart J 1996; 131:499-507. [PMID: 8604629 DOI: 10.1016/s0002-8703(96)90528-1] [Citation(s) in RCA: 158] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
One hundred seven patients underwent atrioventricular (AV)-junctional ablation and pacing for atrial fibrillation, and 90 were alive 2.3 +/- 1.2 years later. Quality of life index (1.9 +/- 1.2 to 3.6 +/- 1.1; 3.6 +/- 1.1; p<0.001) and ease of activities of daily living (2 +/- 0.4 to 2.4 +/- 0.3; p<0.001) were significantly improved. Doctor visits (10 +/- 13 to 5.06 +/-7; p<0.03), hospital admissions (2.8 +/- 6.8 vs 0.17 +/- 0.54; p<0.03, and antiarrhythmic drug trials (6.2 +/- 4 to 0.46 +/- 1.5; p<0.001) decreased significantly after treatment. Congestive heart failure episodes decreased from 18 before to 8 afterward. Twenty-eight of 36 patients with dual-chamber pacemakers remained in a dual-chamber mode at follow-up. Radiofrequency AV-junctional catheter ablation and pacing is a highly successful form of treatment for medically refractory atrial fibrillation.
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Harada N, Chiu V, Damron-Rodriguez J, Fowler E, Siu A, Reuben DB. Screening for balance and mobility impairment in elderly individuals living in residential care facilities. Phys Ther 1995; 75:462-9. [PMID: 7770493 DOI: 10.1093/ptj/75.6.462] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The rapid growth of the elderly population has resulted in a corresponding rise in the number of elderly individuals who experience disability during their lifetimes. The purpose of this study was to test the usefulness of four established clinical measures of balance, gait, and subjective perceptions of fear of falling as screening methods for referring community-dwelling elderly individuals living in residential care facilities for detailed physical therapy evaluation and possible intervention. SUBJECTS The subjects were a convenience sample of 53 elderly individuals living in two residential care facilities for the elderly. METHODS Subjects were tested on each of four clinical measures of balance and mobility. Their performance on these measures was compared with a physical therapist's brief evaluation of disability and appropriateness for more detailed evaluation. The usefulness of these tools as screening methods was determined by calculating sensitivity and specificity levels using the physical therapist's evaluation as a standard. RESULTS The sensitivity and specificity levels of the four clinical measures in their application as screening tests for referral to physical therapy were as follows: Berg Balance Scale, 84% and 78%; balance subscale of the Tinetti Performance-Oriented Mobility Assessment, 68% and 78%; gait speed, 80% and 89%; and Tinetti Fall Efficacy Scale, 59% and 82%. The combination of two tests, Berg Balance Scale and gait speed, yielded the highest sensitivity of 91% and the highest specificity of 70% when a subject tested positive on at least one test. CONCLUSION AND DISCUSSION These findings indicate the feasibility of developing screening methods for referring community-dwelling elderly individuals for a detailed physical therapy evaluation based on established clinical assessment measures, with a combination of tests measuring balance and gait demonstrating the most promising results.
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Affiliation(s)
- N Harada
- Veterans Administration Medical Center-West Los Angeles, CA, USA
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Fitzpatrick AP, Lesh MD, Epstein LM, Lee RJ, Siu A, Merrick S, Griffin JC, Scheinman MM. Electrophysiological laboratory, electrophysiologist-implanted, nonthoracotomy-implantable cardioverter/defibrillators. Circulation 1994; 89:2503-8. [PMID: 8205656 DOI: 10.1161/01.cir.89.6.2503] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Implantable cardioverter/defibrillators (ICDs) have conventionally been implanted in the operating room by surgeons. However, technological developments have reduced size and increased simplicity, bringing the procedure into the realm of the electrophysiologist. The purpose of this study was to evaluate the safety and efficacy of implantation of the entire ICD system by electrophysiologists in an electrophysiology laboratory. METHODS AND RESULTS Between July 1993 and February 1994, 23 patients (21 men; age, 64 +/- 11 years) underwent transvenous ICD implantation by electrophysiologists working alone, entirely in the electrophysiology laboratory. Indications for ICD were sudden death in 10 patients, uncontrolled life-threatening ventricular tachycardia in 12, and syncope with cardiomyopathy and familial sudden death in 1. Seventeen patients had coronary artery disease and a past history of acute myocardial infarction. Four patients had idiopathic dilated cardiomyopathy, 1 had coronary ectasia and poor left ventricular function, and another had poor left ventricular function related to valvular dysfunction. The mean left ventricular ejection fraction was 34 +/- 10% (range, 20% to 50%). General anesthesia was administered in 22 cases, and deep sedation was used in 1 elderly patient. After positioning of transvenous leads and subcutaneous patch/array lead positioning, defibrillation testing was performed. After transvenous and subcutaneous lead tunneling, all generators were placed subcutaneously in an abdominal pocket. The mean total time in the electrophysiology laboratory was 254 +/- 68 minutes (range, 150 to 375 minutes), with 104 +/- 42 minutes for anesthetic and other preparation, 159 +/- 45 minutes for implantation, and 8.7 +/- 5 minutes (range, 3 to 25 minutes) of fluoroscopy required for positioning of transvenous and subcutaneous lead systems. Implant times showed a significant improvement when the first 10 cases (188 +/- 44 minutes) were compared with the last 10 in the series (124 +/- 44 minutes, P < .01). The mean defibrillation threshold was 17 +/- 5 J (range, 5 to 25 J). There were 5 complications (22%): 1 patch-site hematoma, 1 pneumothorax related to subclavian venous puncture, 1 pulmonary embolism, and 2 patients requiring overnight ventilation after hemodynamic deterioration following defibrillation testing. There were no deaths, and there were no infections. The mean time to hospital discharge after the implant was 5.1 +/- 3.5 days. After 11.6 +/- 9 weeks of follow-up, all devices were functioning satisfactorily, all patients had successfully defibrillated at postimplant predischarge checkup with 29 +/- 5 J, and there had been no late complications. CONCLUSIONS This is the first report to show that nonthoracotomy ICD implantation may be successfully carried out by electrophysiologists working alone in the electrophysiology laboratory, with a high rate of success and few complications, even in high-risk patients. This high rate of success and safety probably relates to the availability of high-quality fluoroscopy and familiarity with electrophysiology laboratory equipment and personnel.
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Affiliation(s)
- A P Fitzpatrick
- University of California, Department of Medicine, San Francisco 94143
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Abstract
The corneal thickness of 108 human subjects, ranging from 17 to 75 years of age, was measured using ultrasound pachometry. One central, four mid-peripheral and four peripheral corneal positions along the vertical and horizontal meridians were assessed using ultrasound pachometry. No significant differences were found in the thicknesses of the central, midperipheral or peripheral cornea with increasing age using analysis of variance. These results suggest that ageing has no significant effect on human corneal thickness between the ages of 16 to 75 years. However the high Type II error probability (beta = 0.90) suggests that 108 subjects (18 in each age group) were insufficient to adequately answer the question. Thus power analysis may help explain the conflicting reports available in literature. The diversity in data interpretation may be due to the statistically small sample sizes used in most studies. Power analysis shows that at least 80 subjects are needed in each age group (480 subjects in total) before a statistically reliable test of the null hypothesis is possible. This study emphasizes the importance of power analysis in calculating an adequate sample size.
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Affiliation(s)
- A Siu
- Department of Optometry, University of Auckland, New Zealand
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Abstract
.5% proparacaine HCl is commonly used for topical anaesthesia in ultrasound pachometry prior to refractive surgery. This drug is known to alter corneal epithelial adhesion. Does 0.5% proparacaine result in an alteration in corneal thickness due to changes in the corneal epithelium? Corneal thickness was measured by optical pachometry at 30 sec intervals for 15 min under 3 experimental conditions; 1) 2 drops of artificial tears, 2) 1 drop of 0.5% proparacaine, 3) 2 drops of 0.5% proparacaine. Baseline measurements were recorded before each trial. No significant differences were found between the mean corneal thicknesses measured in the baseline, 2 drops of artificial tears and 1 drop of 0.5% proparacaine conditions. The mean corneal thickness in the 2 drops of 0.5% proparacaine condition was significantly greater than those measured in the other conditions. In particular the measured corneal thickness was significantly different from the baseline measurements 1 to 2 min after instillation of the 2 drops of 0.5% proparacaine. Exponential modelling of the corneal edema recovery function demonstrated that recovery to baseline corneal thickness occurred 7 to 8 min following the instillation of 2 drops of 0.5% proparacaine. The data of this study suggest that only 1 drop of 0.5% proparacaine should be used for topical anaesthesia prior to ultrasound pachometry. This recommendation may minimize the possibility of measuring artifactually large corneal thickness estimates, and thus reduce the possibility of corneal microperforation during refractive surgery.
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Affiliation(s)
- P Herse
- Department of Optometry, University of Auckland, New Zealand
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Calteux N, Boulanger N, Siu A, Previnaire JG, Vanwijck R. An unusual foot replantation. Eur J Plast Surg 1989. [DOI: 10.1007/bf02892707] [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: 10/21/2022]
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Lau HK, Cheung M, Siu A. Isolation and characterization of a specific antibody population against human fibrinogen. Biochem Int 1987; 15:561-9. [PMID: 2447894] [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: 01/01/2023]
Abstract
A specific antibody population against human fibrinogen was isolated from a rabbit antiserum by affinity chromatography on fibrinogen-bound Sepharose gel. Using a sensitive competitive radioimmunoassay, the antibody population was found to recognize epitopes on native fibrinogen but crossreacted minimally with fibrinogen fragment D and an early plasmin-degraded fibrinogen A alpha-chain product, but not at all with fragment E or fibrinopeptides A and B. Fibrin monomers shared part of these epitopes. The antibody population crossreacted to a small extent with bovine, horse and baboon fibrinogens and not at all with fibrinogens from sheep, rat, pig, goat, guinea pig, dog and rabbit.
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Affiliation(s)
- H K Lau
- Department of Biochemistry, University of Hong Kong
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