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Carnero EA, Bock CP, Liu Y, Corbin K, Wohlers-Kariesch E, Ruud K, Moon J, Marcus A, Krajmalnik-Brown R, Muraviev A, Vodopyanov KL, Smith SR. Measurement of 24-h continuous human CH 4 release in a whole room indirect calorimeter. J Appl Physiol (1985) 2023; 134:766-776. [PMID: 36794690 PMCID: PMC10027086 DOI: 10.1152/japplphysiol.00705.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
We describe the technology and validation of a new whole room indirect calorimeter (WRIC) methodology to quantify volume of methane (VCH4) released from the human body over 24 h concurrently with the assessment of energy expenditure and substrate utilization. The new system extends the assessment of energy metabolism by adding CH4, a downstream product of microbiome fermentation that could contribute to energy balance. Our new system consists of an established WRIC combined with the addition of off-axis integrated-cavity output spectroscopy (OA-ICOS) to measure CH4 concentration ([CH4]). Development, validation, and reliability of the system included environmental experiments to measure the stability of the atmospheric [CH4], infusing CH4 into the WRIC and human cross-validation studies comparing [CH4] quantified by OA-ICOS and mid-infrared dual-comb spectroscopy (MIR DCS).Our infusion data indicated that the system measured 24-h [CH4] and VCH4 with high sensitivity, reliability, and validity. Cross-validation studies showed good agreement between OA-ICOS and MIR DCS technologies (r = 0.979, P < 0.0001). Human data revealed 24-h VCH4 was highly variable between subjects and within/between days. Finally, our method to quantify VCH4 released by breath or colon suggested that over 50% of the CH4 was eliminated through the breath. The method allows, for the first time, measurement of 24-h VCH4 (in kcal) and therefore the measurement of the proportion of human energy intake fermented to CH4 by the gut microbiome and released via breath or from the intestine; also, it allows us to track the effects of dietary, probiotic, bacterial, and fecal microbiota transplantation on VCH4.NEW & NOTEWORTHY This is the first time that continuous assessment of CH4 is reported in parallel with measurements of O2 consumption and CO2 production inside a whole room indirect calorimeter in humans and over 24 h. We provide a detailed description of the whole system and its parts. We carried out studies of reliability and validity of the whole system and its parts. CH4 is released in humans during daily activities.
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Affiliation(s)
- E. A. Carnero
- Translational Research Institute, AdventHealth, Orlando, Florida, United States
| | - C. P. Bock
- Translational Research Institute, AdventHealth, Orlando, Florida, United States
| | - Y. Liu
- Translational Research Institute, AdventHealth, Orlando, Florida, United States
| | - K. Corbin
- Translational Research Institute, AdventHealth, Orlando, Florida, United States
| | | | - K. Ruud
- MEI Research, Ltd., Edina, Minnesota, United States
| | - J. Moon
- MEI Research, Ltd., Edina, Minnesota, United States
| | - A. Marcus
- Biodesign Swette Center for Environmental Biotechnology, Arizona State University, Tempe, Arizona, United States
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, United States
| | - R. Krajmalnik-Brown
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, United States
| | - A. Muraviev
- CREOL, College of Optics and Photonics, University of Central Florida, Orlando, Florida, United States
| | - K. L. Vodopyanov
- CREOL, College of Optics and Photonics, University of Central Florida, Orlando, Florida, United States
| | - S. R. Smith
- Translational Research Institute, AdventHealth, Orlando, Florida, United States
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Lazzaro A, Saini A, Elton C, Atkin GK, Mitchell IC, Lotzof K, Marcus A, Mathur P, Boyle DJ. Secondary colonic stent insertion in acute large bowel obstruction following primary stent failure. Ann R Coll Surg Engl 2019; 102:141-143. [PMID: 31660754 DOI: 10.1308/rcsann.2019.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Colonic stent insertion has been shown to be an effective treatment for patients with acute large bowel obstruction, either as a bridge to surgery or as definitive treatment. However, little is known of the role of secondary stent insertion following primary stent failure in patients considered inappropriate or high risk for emergency surgery. METHODS Fourteen patients presenting with acute large bowel obstruction who had previously been treated with colonic stent insertion were studied. All underwent attempted placement of a secondary stent. RESULTS Technical deployment of the stent was accomplished in 12 patients (86%) but only 9 (64%) achieved clinical decompression. Successful deployment and clinical decompression of a secondary stent was associated with older age (p=0.038). Sex, pathology, site of obstruction, duration of efficacy of initial stent and cause of primary failure were unrelated to outcome. No procedure related morbidity or mortality was noted following repeated intervention. CONCLUSIONS Secondary colonic stent insertion appears an effective, safe treatment in the majority of patients presenting with acute large bowel obstruction following failure of a primary stent.
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Affiliation(s)
- A Lazzaro
- Royal Free London NHS Foundation Trust, UK
| | - A Saini
- Royal Free London NHS Foundation Trust, UK
| | - C Elton
- Royal Free London NHS Foundation Trust, UK
| | - G K Atkin
- Royal Free London NHS Foundation Trust, UK
| | | | - K Lotzof
- Royal Free London NHS Foundation Trust, UK
| | - A Marcus
- Royal Free London NHS Foundation Trust, UK
| | - P Mathur
- Royal Free London NHS Foundation Trust, UK
| | - D J Boyle
- Royal Free London NHS Foundation Trust, UK
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Marcus A, Marcus HJ, Camp SJ, Nandi D, Kitchen N, Thorne L. TM1-3 Improved prediction of surgical resectability in patients with glioblastoma multiforme using an artificial neural network. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.27] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesIn managing a patient with glioblastoma multiforme (GBM), a surgeon must weigh up whether sufficient tumour can be removed so that the patient can enjoy the benefits of decompression and cytoreduction, without impacting on the patient’s neurological status. In a previous study we identified the five most important anatomical features on a pre-operative MRI that are predictive of surgical resectability and used them to develop a grading system. The aim of this study was to apply an artificial neural network (ANN) to improve the prediction of surgical resectability.MethodsA prospectively maintained database was searched between February and August 2017 to identify all adult patients with supratentorial GBM that underwent resection. Pre-operative MRI scans were scored using the aforementioned grading system and post-operative scans assessed to determine the extent of resection. Performance of the standard grading system and ANN were then evaluated by analysing their Receiver Operator Characteristic curves; Area Under Curve (AUC) and accuracy were calculated and compared using the t-test with a value of p<0.05 considered significant.ResultsIn all, 47 patients were included, of which 18 (38.3%) were found to have complete excision. The AUC and accuracy were significantly greater using the ANN compared to the standard grading system (0.87 vs. 0.79 and 0.81 vs. 0.77 respectively; p<0.01 in both cases).ConclusionsAn ANN allows for improved prediction of surgical resectability in patients with GBM.
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White D, Cartwright J, Marcus A, Burt M. QUALITY IMPROVEMENT IN ASSISTED LIVING THROUGH A NURSING EDUCATION—COMMUNITY PARTNERSHIP MODEL. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.486] [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)
- D White
- Institute on Aging, Portland State University
| | - J Cartwright
- Oregon Health & Science University School of Nursing
| | - A Marcus
- Oregon Health & Science University School of Nursing
| | - M Burt
- Oregon Health & Science University School of Nursing
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Barzel E, Larkin JW, Marcus A, Reviriego-Mendoza MM, Usvyat LA, Sor M, Maddux FW. Tract dilation to salvage failing buttonholes in arteriovenous dialysis fistulae. J Vasc Access 2018; 20:290-300. [PMID: 30319008 DOI: 10.1177/1129729818804996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hemodialysis patients with an arteriovenous fistula can use buttonhole techniques for cannulation. Although buttonholes generally work well, patients may report difficult and painful cannulation, and buttonholes may fail over time. We aimed to assess the effectiveness of tract dilation in treatment of failing buttonholes. METHODS We retrospectively analyzed data from patients treated with buttonhole tract dilation at an outpatient vascular access center between January 2013 and August 2015. RESULTS Data from 23 patients were analyzed. There were 51 tract dilation procedures during 36 encounters for failing arteriovenous fistula buttonhole tract(s). The technical success rate for established tract dilation with "blunt-recanalization" was 90% (n = 46). The five remaining buttonholes had "sharp-recanalization" to create and dilate new tract through the buttonhole. For 46 buttonholes treated with "blunt-recanalization," there was an 85% clinical success rate at one week (39 buttonholes), and one was lost to follow-up; there was a 70% clinical success rate after one month (32 buttonholes). In the five buttonholes with "sharp-recanalization," there was only one clinical success with p < 0.05 for difference in success rate compared to "blunt-recanalization" at both one week and one month. There was one complication from "sharp-recanalization" requiring abandonment of the buttonhole tract. DISCUSSION Buttonhole tract dilation is a useful method to treat difficult cannulation and painful cannulation and has the potential to extend the life of failing buttonholes.
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Affiliation(s)
- Eyal Barzel
- 1 Azura Vascular Care, Malvern, PA, USA.,2 American Access Care of New Jersey, Cherry Hill, NJ, USA
| | - John W Larkin
- 3 Fresenius Medical Care North America, Waltham, MA, USA
| | - Allen Marcus
- 1 Azura Vascular Care, Malvern, PA, USA.,2 American Access Care of New Jersey, Cherry Hill, NJ, USA
| | | | - Len A Usvyat
- 3 Fresenius Medical Care North America, Waltham, MA, USA
| | - Murat Sor
- 1 Azura Vascular Care, Malvern, PA, USA
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Verdino G, Zelig R, Rigassio Radler D, Marcus A, Touger-Decker R. The Relationship between Prevalence of Risk for Malnutrition and Tooth Loss among Patients Aged 65 and Older Who Came to a University Based Dental School Clinic. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.294] [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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Salvatore D, Touger-Decker R, Ziegler J, Rigassio Radler D, Marcus A, Hughes C. The Relationships Between Weight Status and Dental Caries Experience in Primary Teeth of Patients at a Pediatric Dental Clinic. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.295] [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: 10/19/2022]
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Breitfeller E, Tomesko J, Marcus A, Touger-Decker R. Use of a Computer-Assisted Instruction Module to Teach Nutrition Focused Physical Examination to Pre-Professional Dietetic Students. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.228] [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: 10/19/2022]
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Romano M, Brody R, Marcus A, Touger-Decker R. Comparison of Performance of Advanced Clinical Nutrition Practice Tasks of Registered Dietitian Nutritionists with Graduate Degrees. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.356] [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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Pieroth R, Radler DR, Guenther P, Brewster P, Marcus A. The Relationship between Social Support and Diet Quality in Middle-aged and Older Adults in the U.S. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.114] [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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Gallo S, Brody R, Marcus A, Touger-Decker R. Exploring Practice Activities of Advanced Clinical Practice Registered Dietitian Nutritionists. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.280] [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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Desjardins S, Brody R, Marcus A, Touger-Decker R. Nutrition Focused Physical Examination Practices of Registered Dietitian Nutritionists That Have Completed an In-Person Nutrition Focused Physical Examination Course. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.314] [Citation(s) in RCA: 4] [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: 10/21/2022]
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Gall S, Brody R, Marcus A, Byham-Gray L. Determining Current Level of Research Involvement among Clinical Practice Dietitians in Colorado and New Mexico. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.155] [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: 11/16/2022]
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Gomes A, Ziegler J, Rothpletz-Puglia P, Marcus A. The Relationship between Early Nutritional Status and Pulmonary Function in Pediatric Cystic Fibrosis Patients. J Acad Nutr Diet 2014. [DOI: 10.1016/j.jand.2014.06.085] [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: 10/24/2022]
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Taliaferro-Smith LD, Oberlick EM, Liu T, Eggers C, Kline ER, Nagaraju GPC, Marcus A, O'Regan R. P1-02-06: Silencing of IGF-1R Has Paradoxical Effects in Triple Negative Breast Cancer Phenotypes. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-02-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple negative (TN) breast cancers are a heterogeneous group of breast cancers with a poor prognosis in part due to a lack of effective targeted agents. Insulin-like growth factor-1 receptor (IGF-1R) has been shown to play a role in breast cancer cell proliferation, adhesion, invasion, and migration and is overexpressed in more than a third of TN breast tumors. We hypothesized that IGF-1R could be a therapeutic target for a subset of TN breast cancers. Methods: We evaluated the effects of IGF-1R silencing on the metastatic properties of TN breast cancer cells by knock down in two morphologically distinct TN breast cancer cell lines using shRNA lentiviral techniques. Reverse-transcription polymerase chain reaction (RT-PCR) and immunoblotting were used to detect mRNA and protein expression levels, respectively, of IGF-1R signaling molecules. Anchorage-dependent growth and Matrigel chamber assays were performed to assess the effects of IGF-1R silencing on colony formation and invasion of TN breast cancer cells, respectively; wound-healing and spheroid migration were also performed to assess the effects of IGF-1R inhibition on TN breast cancer cell motility. Results: Stably transfected mesenchymal MDA-MB-231 TN cells showed effective downregulation of IGF-1R protein expression, which resulted in mesenchymal-to-epithelial transition (MET), confirmed by upregulation of the epithelial marker E-cadherin and downregulation of the mesenchymal marker vimentin. Importantly, this MET resulted in reduced colony formation (p<0.0042) and cell motility and dramatically reduced invasion (p<0.0001). Conversely, silencing of IGF-1R in epithelial MDA-MB-468 TN cells induced epithelial-to-mesenchymal transition (EMT), confirmed by downregulation of E-cadherin and upregulation of vimentin expression, with resultant increased colony formation (p<0.006), cell motility, and invasion (p<0.0001). Conclusion: Collectively, these results demonstrate a paradoxical effect of targeting IGF-1R in TN breast cancers of mesenchymal and epithelial origin. Targeting IGF-1R in TN breast cancers with a mesenchymal phenotype decreases invasion and metastatic potential. In contrast, targeting IGF-1R in TN breast cancers with an epithelial phenotype could have potentially detrimental effects. Our data suggest that IGF-1R inhibition should be explored as a therapeutic modality in TN breast cancers with a mesenchymal phenotype.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-02-06.
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Affiliation(s)
- LD Taliaferro-Smith
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - EM Oberlick
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - T Liu
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - C Eggers
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - ER Kline
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - GPC Nagaraju
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - A Marcus
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - R O'Regan
- 1Winship Cancer Institute at Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
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Affiliation(s)
- A Marcus
- AGRICULTURAL RESEARCH SERVICE, UNITED STATES DEPARTMENT OF AGRICULTURE, BELTSVILLE, MARYLAND
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Abstract
We investigated a possible association between attention-deficit/hyperactivity disorder (ADHD) and overweight by measuring weight status and energy expenditure (basal metabolic rate, BMR) in 39 ADHD-boys with hyperactivity (mixed hyperactive/impulsive and inattentive or predominantly hyperactive/impulsive) and 30 healthy boys. The age range for the total group was 8-14 years. Weight and height were measured by a calibrated scales and stadiometer. Body mass index standard deviation scores (BMI-SDS) were calculated. BMR was determined by indirect calorimetry. Significant differences were obtained between the ADHD- and the control-group, but not between ADHD-subgroups. Both BMI-SDS and BMR were higher in the group of ADHD-boys, whereby the differences were more marked when they were older. More overweight and obese subjects were found in the ADHD-sample. Impulsive behavior in ADHD-boys with hyperactivity may lead to an increased food intake, which is then likely to overcompensate the heightened energy expenditure.
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Affiliation(s)
- R Hubel
- Department of Psychology, University of Trier, 54286 Trier, Germany
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Brumley WC, Latorre E, Kelliher V, Marcus A, Knowles DE. Determination of Chlordane in Soil by LC/GC/ECD and LC/GC/EC NIMS with Comparison of ASE, SFE, and SOXHLET Extraction. J LIQ CHROMATOGR R T 2006. [DOI: 10.1080/10826079808006594] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- W. C. Brumley
- a Environmental Sciences Division , U.S. Environmental Protection Agency National Exposure Research Laboratory , P.O. Box 93478, Las Vegas, NV, 89193-3478
| | - E. Latorre
- a Environmental Sciences Division , U.S. Environmental Protection Agency National Exposure Research Laboratory , P.O. Box 93478, Las Vegas, NV, 89193-3478
| | - V. Kelliher
- a Environmental Sciences Division , U.S. Environmental Protection Agency National Exposure Research Laboratory , P.O. Box 93478, Las Vegas, NV, 89193-3478
| | - A. Marcus
- a Environmental Sciences Division , U.S. Environmental Protection Agency National Exposure Research Laboratory , P.O. Box 93478, Las Vegas, NV, 89193-3478
| | - D. E. Knowles
- b Dionex Corporation Salt Lake Technical Center , Salt Lake City, UT, 84119
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Affiliation(s)
- A Marcus
- FIELD CROPS AND ANIMAL PRODUCTS BRANCH, MARKET QUALITY RESEARCH DIVISION, AGRICULTURAL MARKETING SERVICE, UNITED STATES DEPARTMENT OF AGRICULTURE, BELTSVILLE, MARYLAND
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O'Brate A, Marcus A, Giannakakou P. O-189 The combination of farnesyltransferase inhibitors and taxolreverses taxol resistance by enhancing taxol binding to microtubules: Clinical implications for NSCLC therapy. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80323-x] [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: 10/25/2022]
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Cleeland CS, Portenoy RK, Rue M, Mendoza TR, Weller E, Payne R, Kirshner J, Atkins JN, Johnson PA, Marcus A. Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group. Ann Oncol 2005; 16:972-80. [PMID: 15821119 DOI: 10.1093/annonc/mdi191] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [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: 11/14/2022] Open
Abstract
BACKGROUND Cancer pain is highly prevalent and commonly undertreated. This study was designed to determine whether dissemination of a clinical protocol for pain management would improve outcomes in community oncology practices. PATIENTS AND METHODS A pain management protocol was developed based on accepted guidelines. After baseline assessment, oncology practices were randomly assigned to 'analgesic protocol' (AP) sites, where oncologists implemented the guidelines in a group of lung or prostate cancer patients, or to 'physician discretion' (PD) sites, where customary treatment was continued. Patients treated on protocol and a comparison group of patients with pain due to breast cancer or myeloma were monitored for change in pain using the Brief Pain Inventory, and for change in other symptoms or mood. RESULTS The protocol terminated early because of poor accrual. We compared groups using proportions of patients who had no or mild pain at follow-up. Although measures of protocol adherence did not suggest the occurrence of major practice change, the proportion of lung or prostate cancer patients with no or mild pain increased significantly from baseline for those treated at AP sites compared with those treated at PD sites. There was no significant difference between the breast and myeloma patients treated at AP sites versus those treated at PD sites. CONCLUSION A protocol for cancer pain management can improve pain control. Diffusion of these benefits to other patients was not confirmed. Given the small sample size, these findings require confirmation in a larger trial.
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Affiliation(s)
- C S Cleeland
- The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Marcus A. Do some people 'deserve' AIDS? One out of five think they do. Women Alive 2002:14-5. [PMID: 11683003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Hörig H, Wainstein A, Long L, Kahn D, Soni S, Marcus A, Edelmann W, Kucherlapati R, Kaufman HL. A new mouse model for evaluating the immunotherapy of human colorectal cancer. Cancer Res 2001; 61:8520-6. [PMID: 11731437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
A new murine model of human colorectal cancer was generated by crossing human carcinoembryonic antigen (CEA) transgenic mice (H-2K(b)) with adenomatous polyposis coli (Apc1638N) knockout mice (H-2K(b)). The resulting hybrid mice developed gastrointestinal polyps in 6-8 months that progressed to invasive carcinomas with a similar pattern of dysplasia and CEA expression as observed in human colorectal cancer. These animals exhibited incomplete or partial tolerance to CEA as evidenced by delayed growth of CEA-expressing tumors and the inability to inhibit CEA-specific CTL responses. These results have important implications for understanding the role of CEA-specific immunity in human colon cancer patients and suggest that vaccine strategies targeting CEA may be feasible. This model provides a powerful system for evaluating antigen-specific tumor immunity against spontaneous tumors arising in an orthotopic location and permits evaluation of therapeutic vaccine strategies for human colorectal cancer.
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Affiliation(s)
- H Hörig
- Department of Surgery, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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Göpel C, Marcus A. [Initial experiences with amisulpride, an in Germany novel, atypical neuroleptic drug in treatment of adolescents with psychiatric disorders]. Z Kinder Jugendpsychiatr Psychother 2001; 29:230-8. [PMID: 11524899 DOI: 10.1024/1422-4917.29.3.230] [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: 02/21/2023]
Abstract
OBJECTIVES In addition to conventional antipsychotic drugs, during the past decade an increasing number of atypical neuroleptics has been introduced in the treatment of juvenile schizophrenic and schizoaffective disorders. In 1999 Germany legalized the benzamide amisulpride for the treatment of acute and chronic schizophrenic symptoms. Preliminary treatment results are reported here. METHODS Ten adolescent cases are presented with regard to the efficacy, side effects and dosage of amisulpride. RESULTS Preliminary results on the use of amisulpride are promising. The rate of side effects is tolerable. CONCLUSIONS Amisulprise seems to constitute a useful alternative in the treatment of juvenile schizophrenia for those who suffer from intolerable side effects of classical or atypical neuroleptics. Controlled studies are warranted to further clarify its efficacy and safety in the treatment of adolescents.
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Affiliation(s)
- C Göpel
- Krankenanstalt Mutterhaus der Borromäerinnen, Abteilung für Kinder- und Jugendpsychiatrie, Trier
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Göpel C, Marcus A. Erste Erfahrungen mit Amisulprid, einem in Deutschland neuen, atypischen Neuroleptikum in der Behandlung von Jugendlichen mit psychischen Erkrankungen. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 2001. [DOI: 10.1024//1422-4917.29.3.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Fragestellung: Neben den klassischen Neuroleptika finden bei Jugendlichen zunehmend atypische Neuroleptika zur Behandlung schizophrener und schizoaffektiver Psychosen Verwendung. Seit Beginn des Jahres 1999 ist in Deutschland in der Behandlung akuter schizophrener Psychosen ein neues, offensichtlich wirkungsvolles Neuroleptikum aus der Gruppe der Benzamide verfügbar: Amisulprid. Erste Erfahrungen mit der Anwendung von Amisulprid werden berichtet. Methode: Zehn gut dokumentierte Behandlungsverläufe bei Jugendlichen unter Behandlung mit Amisulprid werden hinsichtlich Effektivität, unerwünschter Wirkungen und Dosierung berichtet. Ergebnisse: Erste Erfahrungen im Einsatz von Amisulprid sind insbesondere wegen der erheblich günstigeren Nebenwirkungsprofile bei überzeugender antipsychotischer Wirksamkeit vielversprechend. Schlussfolgerungen: Amisulprid scheint bei solchen Jugendlichen eine geeignete pharmakotherapeutische Alternative zu sein, die ein erhöhtes Auftreten von Nebenwirkungen unter atypischer neuroleptischer Medikation zeigen. Kontrollierte Studien sind nötig, um die Effektivität und Sicherheit dieser Substanz auch im Jugendalter sicher einschätzen zu können.
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Affiliation(s)
- Ch. Göpel
- Abteilung für Kinder- und Jugendpsychiatrie, Krankenanstalt Mutterhaus der Borromäerinnen, Trier, Germany
| | - A. Marcus
- Akademisches Lehrkrankenhaus (Leiter: PD Dr. A. Marcus), Johannes-Gutenberg-Universität Mainz, Germany
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Abstract
Relationships between serum cholesterol and suicidal behavior have been reported. As suicidal behavior is common in cocaine dependence, we looked for a relationship with serum cholesterol. To do this, we compared 57 cocaine-dependent patients who had attempted suicide with 111 cocaine-dependent patients who had never attempted suicide for their admission total serum cholesterol levels. We found that there were no significant differences between cocaine-dependent patients who had or had not attempted suicide in their total serum cholesterol levels. Also, there were no significant correlations between total serum cholesterol levels and scores on the Barratt Impulsivity Scale. Thus, admission total serum cholesterol does not appear to be clinically useful in the assessment of suicidal behavior in cocaine-dependent patients.
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Affiliation(s)
- A Roy
- Psychiatry Service (116A), Department of Veterans Affairs, New Jersey Healthcare System, 385 Tremont Avenue, East Orange, NJ 07018, USA.
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Marcus A, Broekman M, Drosopoulos J, Pinsky D, Islam N, Gayle R, Maliszewski C. Thromboregulation by endothelial cells: significance for occlusive vascular diseases. Arterioscler Thromb Vasc Biol 2001; 21:178-82. [PMID: 11156849 DOI: 10.1161/01.atv.21.2.178] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [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: 11/16/2022]
Abstract
-During their 7- to 9-day lifespan in the circulation, platelets perform an ill-defined baseline function that maintains the integrity of the vasculature. In thrombocytopenic states, there is an increase in vascular permeability and fragility, which is presumably due to absence of this platelet function. In sharp contrast, biochemical or physical injury in the coronary, carotid, or peripheral arteries induces platelet activation and platelet recruitment, which can progress to thrombotic vascular occlusion. Because there is 1 death every 33 seconds from vascular occlusion in the United States, this problem has critical public health implications. In this review, we describe the characterization of a novel potential antithrombotic agent with a unique mode of action-biochemical "deletion" of ADP from an activated platelet releasate, which thereby inhibits platelet recruitment and further activation.
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Affiliation(s)
- A Marcus
- VA New York Harbor Healthcare System and Weill Medical College of Cornell University, New York, NY 10010, USA.
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Abstract
Hepatocyte growth factor (HGF) exerts multifunctional regulatory roles in the growth, morphogenesis, differentiation, and motility of epithelial cells, and putatively plays important roles in tumor angiogenesis and metastasis. Aside from the full-length protein, 2 naturally occurring truncated HGF isoforms (NK1 and NK2) have been identified. Recent evidence suggests that a high level of HGF in surgically resected non-small-cell lung carcinoma (NSCLC) is a negative prognostic marker for NSCLC patients' survival. The origin of HGF in these tumors remains uncertain. We show here by in situ hybridization and immunohistochemistry that HGF messenger RNA (mRNA) and protein were predominantly expressed by the tumor cells in a high percentage of primary NSCLC. Stromal cell expression of HGF was limited to some lymphocytes and endothelial cells. Normal bronchial and bronchiolar epithelial cells also expressed HGF mRNA and immunoreactive protein. The mRNA transcripts and putative proteins of all 3 known HGF isoforms were detected in both normal lung and lung cancer tissues, but the full-length HGF was predominantly expressed. Our findings indicate that both autocrine and paracrine functions of HGF are likely to contribute to the pathobiology of lung cancer in vivo.
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Affiliation(s)
- M S Tsao
- Department of Laboratory Medicine and Pathobiology, University Health Network and University of Toronto, Toronto, Canada
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Abstract
METHOD A case of life-threatening tonsil hyperplasia probably induced by severe bulimia nervosa is reported. A 14-year-old obese Caucasian girl developed severe dyspnea caused by an enlarged hyperplastic lingual tonsil after referral to a child and adolescent psychiatry unit after a suicide attempt during a family conflict. The enlargement of the lingual tonsil was seen 6 months after the development of severe bulimia nervosa. Surgical extirpation of the hyperplastic tissue was done without complications. Hyperplasia of lymphatic tissue associated with bulimia nervosa has never been described before. RESULTS AND DISCUSSION There was no atopic or infectious history in this case. Presumably, excessive vomiting led to extreme tonsillar growth by irritating the lymphocyte tissue. The relationship between bulimia nervosa and tonsil hyperplasia is far from clear. Further clinical observations are necessary.
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Affiliation(s)
- C Göpel
- Hospital "Mutterhaus der Borromäerinnen," Department of Child and Adolescent Psychiatry/Center for Psychobiological and Psychosomatic Research, University of Trier, Trier, Germany
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Kaplan CP, Bastani R, Belin TR, Marcus A, Nasseri K, Hu MY. Improving follow-up after an abnormal pap smear: results from a quasi-experimental intervention study. J Womens Health Gend Based Med 2000; 9:779-90. [PMID: 11025870 DOI: 10.1089/15246090050147754] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The success of cervical cancer control programs depends on regular screening with the Pap smear test and prompt and appropriate treatment of early neoplastic lesions. Recognizing the potentially grave consequences of lack of follow-up for abnormal Pap smears, numerous intervention studies have tested the impact of a variety of strategies to increase return for follow-up. The majority of these studies were evaluated under controlled experimental conditions. Despite the encouraging findings of these trials, the next step in the research continuum requires that the effectiveness of these interventions be demonstrated in real world settings before full implementation is initiated. We report the results of an evaluation study assessing the combined effectiveness of three intervention modalities found effective in prior randomized studies: a tracking follow-up protocol, transportation incentives, and financial incentives. This study used a before-after, nonequivalent control group design to assess the impact of a multifaceted intervention that included a computerized tracking protocol with transportation and financial incentives. The study was implemented at two major hospitals, two comprehensive health centers (CHC), and nine public health centers (PHC) under the jurisdiction of the Los Angeles County Department of Health Services. One hospital, one CHC, and the four PHC located in the catchment area of the CHC were selected as experimental sites. The control sites - one hospital, one CHC, and five PHC - provided usual care. All women with an abnormal Pap smear at the intervention and control sites were included in the study. The study consisted of a 1-year period of baseline data collection (September 1989-August 1990), followed by a 2(1/2)-year intervention period (September 1990-February 1993). During the intervention period, the intervention protocol was implemented at the experimental sites, and the control sites provided usual care. Overall, we found that the rates of receipt of follow-up care were consistent with those found in similar studies. In contrast to results obtained in these prior randomized trials, we did not find strong and consistent evidence for intervention effects. Significant findings emerged only at the CHC and hospital levels and only for selected years. Results underscore the importance of testing interventions in real world conditions before large-scale implementation is initiated. In addition, this study highlights the challenge of detecting intervention effects in large-scale studies because of the greater measurement difficulties in field studies as compared with controlled experiments.
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Affiliation(s)
- C P Kaplan
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California 94143-0856, USA
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Abstract
Administration of exogenous insulin (INS) inhibits secretin-stimulated pancreatic bicarbonate (HCO3) output via a dose-dependent, neurally mediated mechanism. To determine whether this effect was due to systemic hyperinsulinemia or to reduced endogenous insulin production, we examined the effect of hyperglycemia on secretin-stimulated pancreatic secretion. Chronic pancreatic fistulae were created in six dogs. After 30 minutes of equilibration, a computer-assisted hyperglycemic clamp protocol was used to maintain glucose (GLU) levels 100 or 150 mg/dL above basal in clamp animals; control animals received volume- and rate-matched infusions of 0.9% saline. One hour after beginning the clamp period, intravenous secretin dose-response (16-125 ng/kg/h) was begun, doubling the dose every half hour. Unstimulated (0-30 minutes) HCO3, GLU, and INS levels did not differ between groups. INS and GLU levels in clamp animals were significantly elevated during clamp (30-90 minutes) and stimulated (90-210 minutes) periods. For the same periods, HCO3 secretion was not significantly changed despite profound hyperinsulinemia. We conclude that systemic hyperinsulinemia alone does not inhibit secretin-stimulated HCO3 output. Since exogenous INS exerts feedback regulation on the pancreas, we propose that suppression of endogenous INS secretion mediates the previously reported inhibitory response.
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Affiliation(s)
- T Simon
- Atlanta Veteran Affairs Medical Center, and Department of Surgery, Emory University, Georgia 30033, USA
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Abstract
OBJECTIVE To learn more about the way that practitioners of traditional Chinese medicine (TCM) diagnose women who have menopausal symptoms. DESIGN We assembled a cohort of 23 postmenopausal women who had hot flushes and were otherwise healthy. Each woman was examined independently by nine practitioners of TCM on the same day. Examination consisted of medical history and physical examination. Diagnoses were recorded and counted. RESULTS The most frequent diagnosis made by the practitioners of TCM was kidney yin deficiency, which was the diagnosis made after 168 of 207 visits (81%); 23 women seen by nine TCM practitioners. Practitioners showed good agreement regarding presence of kidney yin deficiency: in 12 women (52%), this diagnosis was made by eight of nine practitioners; in 16 women (70%), seven of nine practitioners made this diagnosis; and in all 23 women (100%), at least five of nine practitioners made this diagnosis. CONCLUSIONS Practitioners of TCM who diagnose postmenopausal women with vasomotor symptoms are likely to make a diagnosis that includes kidney yin deficiency.
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Affiliation(s)
- B Zell
- Department of Obstetrics and Gynecology, Kaiser Permanente Medical Centers, Richmond, California 94801-2565, USA
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Baier M, Calonge N, Cutter G, McClatchey M, Schoentgen S, Hines S, Marcus A, Ahnen D. Validity of self-reported colorectal cancer screening behavior. Cancer Epidemiol Biomarkers Prev 2000; 9:229-32. [PMID: 10698488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
End points for trials promoting cancer screening are often based on self-reported screening behavior. This study was designed to evaluate and optimize the reliability of a computer-assisted telephone interview for collecting self-reported colorectal cancer screening behavior. Cases who had received a fecal occult blood test (FOBT), flexible sigmoidoscopy, and/or colonoscopy, and controls who had no record of colorectal screening were identified among 40-75-year-old members of the Denver Kaiser Permanente Health Care Program and were contacted by telephone. Sensitivities and specificities of self-reported screening were calculated by comparison of subjects' recall with Kaiser Permanente records. The questionnaire was revised based upon results of the pilot phase of the study. Using the revised questionnaire, the sensitivity of self-reported screening was 96.2% for the FOBT, 94.9% for flexible sigmoidoscopy, 88.7% for colonoscopy, and 96.2% for either endoscopic screening test. The specificity of self-reported screening was 85.9% for the FOBT, 92.2% for flexible sigmoidoscopy, 96.8% for colonoscopy, and 92.0% for either endoscopic screening test. No marked differences in the accuracy of the self-reports were detected as a function of gender, age, ethnicity, or family history of colorectal cancer of the participants. Self-reports of colon cancer screening behavior can be reliably used as end points for intervention trials when carefully phrased questions are used.
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Affiliation(s)
- M Baier
- American Medical Center Cancer Research Center, Lakewood, Colorado 80214, USA.
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36
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Sobanski E, Marcus A, Hennighausen K, Hebebrand J, Schmidt MH. Further evidence for a low body weight in male children and adolescents with Asperger's disorder. Eur Child Adolesc Psychiatry 1999; 8:312-4. [PMID: 10654125 DOI: 10.1007/s007870050106] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The study explores the common clinical impression and previously reported finding by Hebebrand et al. (7) of reduced body weight in male children and adolescents with Asperger's disorder (AD). Body weight and height of 36 consecutively admitted male patients with AD were retrospectively assessed for the calculation of body mass indices (BMI, kg/m2). The BMIs were transformed to percentile ranks and plotted into BMI-centiles representative for the German population. In addition, comorbid psychopathology was assessed to explore a possible relationship between associated psychopathology and body weight. The mean BMI-centile of all patients was 34.7 +/- 31.8 and, thus, differed significantly from the mean centile of an age- and gender-matched psychiatric control group, which was 52.7 +/- 28.3. Thirteen patients had a BMI below the 10th centile and five even below the third. Three of the latter presented with disturbed eating behaviour. Altogether four patients showed disturbed eating behaviour. They had a significantly lower mean BMI-centile than the rest of the group. The BMI-centiles of patients with other additional psychopathology did not differ significantly from the mean percentile of the whole cohort. The results clearly show an increased risk for underweight and disturbed eating behaviour in patients with Asperger's disorder which should be evaluated in further studies.
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Affiliation(s)
- E Sobanski
- Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Mannheim, Germany
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37
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Habib CM, Kugel G, Marcus A. Preliminary report: laboratory-induced stain removal as assessed by environmental scanning electron microscopy. J Clin Dent 1999; 9:64-6. [PMID: 10518864] [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: 02/14/2023]
Abstract
Environmental scanning electron microscopy (ESEM) was employed to observe stain removal during brushing with Arm & Hammer Dental Care and Crest Regular Toothpaste. ESEM allows serial examinations of the same sample, and does not require a destructive preparative process. Three extracted molars were cleaned, placed into a 96-hour broth culture of Streptococcus mutans, and stain was produced with undiluted chlorhexidine rinse, concentrated coffee and tea for a period of 23 days. After staining, the teeth were examined by ESEM, then brushed using a toothbrushing machine. Imaging was repeated after 5, 10, 15 and 30 seconds of brushing. As seen with ESEM, the Arm & Hammer product had different effects than those from the distilled water control, suggesting something other than that expected from abrasive and mechanical forces alone. There were also differences from the Crest dentifrice removal on this single sample, suggesting a possible difference between the two products. Further studies are needed to confirm and explain these effects.
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Affiliation(s)
- C M Habib
- Tufts University School of Dental Medicine, Department of Restorative Dentistry, Boston, MA, USA
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38
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Lipkus IM, Crawford Y, Fenn K, Biradavolu M, Binder RA, Marcus A, Mason M. Testing different formats for communicating colorectal cancer risk. J Health Commun 1999; 4:311-324. [PMID: 10790787 DOI: 10.1080/108107399126841] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study assessed the extent to which different formats of informing men and women age 50 and over of the risks of colorectal cancer (CRC) affected their perceptions of their absolute and comparative (self versus other) 10-year and lifetime risks; emotional reactions about getting CRC; and screening intentions. Forty-four men and 78 women received information about the absolute lifetime risk of getting CRC. In addition, participants either did or did not receive information about (1) lifetime risk of getting CRC compared with other cancers, and (2) risk factors for CRC (age and polyps). Participants who received risk factors information were more likely to increase their perceived absolute 10-year and lifetime risks of getting CRC compared with participants who did not receive risk factors information. In addition, participants who received risk factors information were more likely to believe age was related to getting CRC and felt at greater risk for having polyps compared with participants who did not receive this information. None of the experimental conditions affected how worried, anxious, and fearful participants felt about getting CRC, nor did they affect screening intentions. Independent of experimental condition, participants tended to increase their intentions to get screened for CRC in the next year or two. Intention to be screened was more pronounced among participants who had been screened via a fecal occult blood test (FOBT) or sigmoidoscopy (SIG). Implications for the design of interventions involving the communication of CRC risks are discussed.
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Affiliation(s)
- I M Lipkus
- Duke University Medical Center, Durham, NC 27701, USA
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39
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Griffin S, Marcus A, Schulz T, Walker S. Calculating the interindividual geometric standard deviation for use in the integrated exposure uptake biokinetic model for lead in children. Environ Health Perspect 1999; 107:481-7. [PMID: 10339449 PMCID: PMC1566570 DOI: 10.1289/ehp.99107481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The integrated exposure uptake biokinetic (IEUBK) model, recommended for use by the U.S. Environmental Protection Agency at residential Superfund sites to predict potential risks to children from lead exposure and to establish lead remediation levels, requires an interindividual geometric standard deviation (GSDi) as an essential input parameter. The GSDi quantifies the variability of blood lead concentrations for children exposed to similar environmental concentrations of lead. Estimates of potential risks are directly related to the GSDi, and therefore the GSDi directly impacts the scope of remediation at Superfund sites. Site-specific GSDi can be calculated for sites where blood lead and environmental lead have been measured. This paper uses data from blood and environmental lead studies conducted at the Bingham Creek and Sandy, Utah, Superfund sites to calculate GSDi using regression modeling, box modeling, and structural equation modeling. GSDis were calculated using various methods for treating values below the analytical method detection and quantitation limits. Treatment of nonquantifiable blood lead concentrations affected the GSDi more than the statistical method used to calculate the GSDi. For any given treatment, the different statistical methods produced similar GSDis. Because of the uncertainties associated with data in the blood lead studies, we recommend that a range of GSDis be used when analyzing site-specific risks associated with exposure to environmental lead instead of a single estimate. Because the different statistical methods produce similar GSDis, we recommend a simple procedure to calculate site-specific GSDi from a scientifically sound blood and environmental lead study.
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Affiliation(s)
- S Griffin
- U.S. Environmental Protection Agency, Region VIII, Denver, Colorado, USA
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Hogan K, Marcus A, Smith R, White P. Integrated exposure uptake biokinetic model for lead in children: empirical comparisons with epidemiologic data. Environ Health Perspect 1998; 106 Suppl 6:1557-67. [PMID: 9860915 PMCID: PMC1533426 DOI: 10.1289/ehp.98106s61557] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The concept of model validation is evolving in the scientific community. This paper addresses the comparison of observed and predicted estimates as one component of model validation as applied to the integrated exposure uptake biokinetic (IEUBK) model for lead in children. The IEUBK model is an exposure (dose)-response model that uses children's environmental lead exposures to estimate risk of elevated blood lead (typically > 10 micrograms/dl) through estimation of lead body burdens in a mass balance framework. We used residence-specific environmental lead measurements from three epidemiologic datasets as inputs for the IEUBK model to predict blood lead levels, and compared these predictions with blood lead levels of children living at these residences. When the IEUBK modeling focused on children with representative exposure measurements, that is, children who spent the bulk of their time near the locations sampled, there was reasonably close agreement between observed and predicted blood lead distributions in the three studies considered. Geometric mean observed and predicted blood lead levels were within 0.7 microgram/dl, and proportions of study populations expected to be above 10 micrograms/dl were within 4% of those observed.
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Affiliation(s)
- K Hogan
- Office of Prevention, Pesticides and Toxic Substances, U.S. Environmental Protection Agency, Washington, DC 20460, USA.
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Schlemmer HP, Möckel R, Marcus A, Hentschel F, Göpel C, Becker G, Köpke J, Gückel F, Schmidt MH, Georgi M. Proton magnetic resonance spectroscopy in acute, juvenile anorexia nervosa. Psychiatry Res 1998; 82:171-9. [PMID: 9754441 DOI: 10.1016/s0925-4927(98)00019-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Anorexia nervosa is usually associated with a shrinkage of the brain that is at least partially reversible with weight gain. The pathogenesis of this brain abnormality is unclear. The purpose of this study was to investigate potential alterations in localized proton magnetic resonance (1H MR) spectra of anorectic patients immediately after an interval of excessive weight loss. Twelve patients and seventeen control subjects were examined. Water suppressed 1H MR spectra were recorded from two voxels placed in the thalamus and in the parieto-occipital white matter. The spectra of ten patients could be evaluated. Comparing patients and control subjects, significantly higher signal intensity ratios of choline containing compounds (Cho) relative to total creatine (Cr) as well as significantly lower ratios of N-acetyl-aspartate (NAA) relative to Cho were found in the white matter region. We hypothesize that these results indicate an abnormal starvation, associated membrane turnover, which predominantly takes place in the white matter. No evidence for neuronal degeneration was found in the thalamus or in the white matter region.
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Affiliation(s)
- H P Schlemmer
- Institute for Clinical Radiology Mannheim, Faculty of Medicine, University of Heidelberg, Germany.
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Leigh I, Marcus A, Dobosh P, Allen T. Deaf/hearing cultural identity paradigms: modification of the deaf identity development scale. J Deaf Stud Deaf Educ 1998; 3:329-338. [PMID: 15579872 DOI: 10.1093/oxfordjournals.deafed.a014360] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The Deaf Identity Development Scale (Glickman, 1993) was modified to include hearing individuals and examine how hearing and deaf adults identify themselves. Statistical analysis based on 244 deaf, hard-of-hearing, and hearing respondents revealed a significant interaction between hearing status of self and parents on the hearing, marginal, and immersion scales of the modified version but not on the bicultural scale. Codas are more marginalized, less immersed, and similarly 'hearing' in comparison to deaf persons with deaf parents. Hard-of-hearing respondents with deaf parents endorse more hearing values and fewer deaf values in comparison to deaf counterparts and also appear to be more marginalized. There were no significant differences between deaf and hard-of-hearing individuals with hearing parents. Compared to hearing respondents with hearing parents, deaf counterparts were more marginalized, more 'hearing,' and equally 'deaf.' Strong professional affiliation with the deaf community resulted in scores that differed significantly from those for individuals not as strongly affiliated. We discuss implications for identity development.
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Affiliation(s)
- I Leigh
- Department of Psychology, Gallaudet University, 800 Florida Avenue, NE, Washington, DC 20002, USA
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Schmidt MH, Möcks P, Lay B, Eisert HG, Fojkar R, Fritz-Sigmund D, Marcus A, Musaeus B. Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial. Eur Child Adolesc Psychiatry 1997; 6:88-95. [PMID: 9257090 DOI: 10.1007/bf00566671] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 02/05/2023]
Abstract
A crossover 'placebo'-controlled, double-blind design was used to examine the effectiveness of an oligoantigenic diet in 49 children with hyperactive/disruptive behavior disorder. Effects of diet were compared with those yielded by stimulant medication (methylphenidate). The study was conducted in an inpatient unit at the Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Mannheim. Change in behavior was measured in standardized situations by trained raters, including behavior assessment when testing with CPT and PAT, during a free play situation, and at school. Twelve children (24%) showed significant behavioral improvement in two behavior ratings during diet relative to control diet conditions. Methylphenidate used in 36 children yielded more responders (44%) than diet. The amount of positive changes in behavior in those who received both treatments was about the same. Although only effective in a minority of children, dietary treatment cannot be neglected as a possible access to treating hyperactive/disruptive children and merits further investigation.
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Affiliation(s)
- M H Schmidt
- Central Institute of Mental Health, Department of Child and Adolescent Psychiatry, Mannheim, Germany
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44
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Marcus A. Poem: the disease. West J Med 1997; 166:220. [PMID: 18751071 PMCID: PMC1304129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Hentschel F, Marcus A, Klein M, Schmidt MH. [Joubert's syndrome: computerized tomography and magnetic resonance tomography]. ROFO-FORTSCHR RONTG 1996; 165:210-2. [PMID: 8924679 DOI: 10.1055/s-2007-1015744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F Hentschel
- Abteilung Neuroradiologie, Zentralinstitutes für Seelische Gesundheit, Mannheim
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46
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Laucht M, Esser G, Schmidt MH, Ihle W, Marcus A, Stöhr RM, Weindrich D. [4 1/2 years later: Mannheim risk children of preschool age]. Z Kinder Jugendpsychiatr Psychother 1996; 24:67-81. [PMID: 9459666] [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: 02/06/2023]
Abstract
The present investigation was concerned with the impact of prenatal and perinatal complications (biological risks) and of family adversity (psychosocial risks) on developmental status at age 4 1/2. In a prospective study the developmental course of 362 children (including 210 high-risk children) was followed from birth to age 4 1/2 years. A multilevel approach was used to assess all relevant domains of functioning (i.e. motor, cognitive and social-emotional development). The goal was to obtain information about the effects of biological and psychosocial risks alone and together on outcome in the different domains of functioning. The results show that psychosocial risk factors posed the greatest threat to normal development. Children with psychosocial risks were significantly behind those without such risks in all areas of functioning. Biological risks mainly affected motor development, their negative effects on cognitive and social-emotional functioning having been largely compensated for by age 4 1/2. The extent of an adverse outcome was related to both the degree of risk load and the number of risk factors, whereas interactions among risks were of only minor relevance. An adverse outcome is not inevitable, however: Despite the risks most of the at-risk children showed normal development at age 4 1/2.
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Affiliation(s)
- M Laucht
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters des Zentralinstituts für Seelische Gesundheit in Mannheim
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Abstract
The development of the 12-item Cross-Cultural Smell Identification Test (CC-SIT), based upon items from the University of Pennsylvania Smell Identification Test (UPSIT), is described. In developing this test, the authors initially selected UPSIT items that are familiar to most persons from North American, European, South American, and Asian cultures. The CC-SIT was then administered to 198 people ranging in age from 5 to 96 years, and the the test scores were compared to analogous items from UPSITs administered to 198 age-, sex-, race-, and smoking-habit-matched control subjects. Since the pattern of test scores did not differ for the two groups, the authors developed normative data for the 12-item test using equivalent UPSIT items sampled from a database containing UPSIT scores for 3760 subjects. Norms are provided for determining the percentile ranks of a given patient's score as a function of age and gender. The CC-SIT provides, for the first time, a self-administered means for reliably assessing olfactory function in less than 5 minutes.
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Affiliation(s)
- R L Doty
- Smell and Taste Center, Hospital of the University of Pennsylvania, Philadlephia, 19104, USA
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Marcus A, Ammermann C, Klein M, Schmidt MH. Munchausen syndrome by proxy and factitious illness: symptomatology, parent-child interaction, and psychopathology of the parents. Eur Child Adolesc Psychiatry 1995; 4:229-36. [PMID: 8608388 DOI: 10.1007/bf01980487] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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
The term Munchausen syndrome by proxy is used to diagnose children presenting symptoms of an organic disorder resulting from manipulations initiated by their caretakers. Even in early infancy it happens that injuries are induced, and that drugs, poisons or medicine are administered in order to provoke and feign clinical symptoms of severe diseases. Exact data on prevalence are not available but it is obvious that Munchausen syndrome by proxy is a rare psychiatric disorder. There is a body of evidence that Munchausen syndrome by proxy is nothing but the extreme of a broader clinical entity for which the term factitious illness has been introduced. In this group children are included whose mothers invent a history of disease in order to produce symptoms without actually damaging their children. It is not well established whether such a distinction is necessary and whether there are differences in long-term outcome. Onset of symptoms is as early as three weeks up to twelve years, and mean age of diagnosis according to a more comprehensive study is 3 1/4 year. The estimated mortality rate of children with Munchausen syndrome by proxy is 9 percent. In three of the four cases of children reported here clinical presentations were dominated by symptoms of central nervous disorders. All mothers showed unsure and inconsistent parental behaviour and inefficient coping. None of them received support from their partners, if present. In interaction the children always wanted to dominate their mothers. The high amount of personality disorders observed in the caretakers might be the reason for the often reported failure of psychotherapeutic interventions.
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Affiliation(s)
- A Marcus
- Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Mannheim, Germany
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Marcus A, Schmidt MH. [Possibilities of concomitant drug treatment of stuttering in childhood and adolescence]. Z Kinder Jugendpsychiatr 1995; 23:182-94. [PMID: 7571877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Marcus
- Klinik für Kinder- und Jugendpsychiatrie am Zentralinstitut für Seelische Gesundheit Mannheim
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Abstract
An 11-year-old boy with psychiatric symptoms was brought to the pediatric clinic by his father. The boy exhibited anxiety, sometimes exaggerating to panic reactions, rage, and disorientation. Because of the boy's behavior it was presumed he was having delusions. Careful physical examination revealed evidence of physical abuse. This article alerts readers to the possible combination of physical abuse and purposeful drug administration.
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Affiliation(s)
- A Marcus
- Central Institute of Mental Health, Child Psychiatric Clinic, Mannheim, FRG
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