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Litmanovich-Cohen L, Yaroslavsky A, Halevy-Yosef LR, Shilton T, Enoch-Levy A, Stein D. Post-hospitalization Daycare Treatment for Adolescents With Eating Disorders. Front Psychiatry 2021; 12:648842. [PMID: 34135782 PMCID: PMC8200532 DOI: 10.3389/fpsyt.2021.648842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background: There are several possible facilities for the treatment of eating disorders (EDs). Specifically, there is the issue of the use of specialized daycare and ambulatory services over inpatient settings and the place of daycare programs following inpatient treatment. Aim: We sought to examine the contribution of post-hospitalization daycare program to the treatment of adolescents hospitalized with an ED. Methods: We assessed 61 female adolescents hospitalized with an ED. All but three were diagnosed with clinical or subthreshold anorexia nervosa (AN). Three were diagnosed with bulimia nervosa. Thirty-seven patients continued with a post-hospitalization daycare program for at least 5 months, whereas 24 did not enter or were enrolled in the program for <5 months. Patients completed on admission to, and discharge from, inpatient treatment self-rating questionnaires assessing ED-related symptoms, body-related attitudes and behaviors, and depression and anxiety. Social functioning was assessed 1 year from discharge using open-ended questions. One-year ED outcome was evaluated according to the patients' body mass index (BMI) and according to composite remission criteria, assessed with a standardized semistructured interview. To be remitted from an ED, patients were required to maintain a stable weight, to have regular menstrual cycles, and not to engage in binging, purging, and restricting behaviors for at least eight consecutive weeks before their assessment. Results: BMI was within normal range at follow-up, whether completing or not completing daycare treatment, and around 75% of the patients had menstrual cycles. By contrast, when using comprehensive composite remission criteria, less than a quarter of former inpatients not entering/not completing daycare program achieved remission vs. almost a half of the completers. In addition, a greater percentage of completers continued with psychotherapy following discharge. Fifty percent of both groups showed good post-discharge social functioning. No between-group differences were found in the BMI and the scores of the self-rating questionnaires at admission to, and discharge from, inpatient treatment. Conclusion: Adolescent females with EDs can maintain a normal-range BMI from discharge to 1-year follow-up, even if not completing daycare treatment. By contrast, completion of a post-hospitalization daycare program may improve the 1-year follow-up ED-related outcome of former ED inpatients.
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Affiliation(s)
- Liron Litmanovich-Cohen
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Hadarim Eating Disorders Outpatient Service, Shalvata Mental Health Center, Hod Hsaharon, Israel
| | - Amit Yaroslavsky
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Liron Roni Halevy-Yosef
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Tal Shilton
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Modan-Moses D, Yaroslavsky A, Pinhas-Hamiel O, Levy-Shraga Y, Kochavi B, Iron-Segev S, Enoch-Levy A, Toledano A, Stein D. Prospective Longitudinal Assessment of Linear Growth and Adult Height in Female Adolescents With Anorexia Nervosa. J Clin Endocrinol Metab 2021; 106:e1-e10. [PMID: 32816013 DOI: 10.1210/clinem/dgaa510] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Growth retardation is an established complication of anorexia nervosa (AN); however, findings concerning the adult height of AN patients are inconsistent. OBJECTIVE The objective of this work was to assess linear growth and adult height in female adolescents with AN. DESIGN AND SETTING A prospective observational study was conducted in a tertiary university hospital. PARTICIPANTS Participants included all 255 female adolescent AN patients hospitalized in the pediatric psychosomatic department between January 1, 2000 and May 31, 2015. INTERVENTIONS Height and weight were assessed at admission and during hospitalization. Patients were subsequently invited for measurement of adult height. Additional data collected included premorbid height data, menstrual history, skeletal age, pertinent laboratory studies, and parental heights. MAIN OUTCOME MEASURE The main outcome measure of this study was adult height. RESULTS Mean age at admission was 15.4 ± 1.75 years, mean body mass index (BMI) was 15.7 ± 1.8 kg/m2 (BMI SDS = -2.3 ± 1.45 kg/m2). Premorbid height SD scores (SDS) were not significantly different from those expected in normal adolescents (0.005 ± 0.96). However, height SDS at admission (-0.36 ± 0.99), discharge (-0.34 ± 0.96), and at adult height (-0.29 ± 0.95), were significantly (P < .001) lower than expected. Furthermore, adult height was significantly (P = .006) shorter compared to the midparental target height. Stepwise forward linear regression analysis identified age (r = 0.32, P = .002) and bone age (r = -0.29, P = .006) on admission, linear growth during hospitalization (r = 0.47, P < .001), and change in luteinizing hormone during hospitalization (r = -0.265, P = .021) as independent predictors of improvement in height SDS from the time of admission to adult height. CONCLUSIONS Whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Amit Yaroslavsky
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yael Levy-Shraga
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Brigitte Kochavi
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Sharon Iron-Segev
- Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
- School of Nutrition, Peres Academic Center, Rehovot, Israel
| | - Adi Enoch-Levy
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Toledano
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Kochavi B, Mendelowitsch S, Enoch-Levy A, Yaroslavsky A, Toledano A, Modan-Moses D, Stein D. Resting energy expenditure in acutely ill and stabilized patients with anorexia nervosa and bulimia nervosa. Int J Eat Disord 2020; 53:1460-1468. [PMID: 32506564 DOI: 10.1002/eat.23301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Determining resting energy expenditure (REE) may be important in the nutritional assessment of adolescents with eating disorders (EDs). Calculated equations assessing REE, developed according to data from healthy people, may under- or overestimate REE in EDs. We have sought to compare the REE measured in clinical settings to that calculated using equations in actively ill adolescents with anorexia nervosa (AN) and bulimia nervosa (BN), and following stabilization of weight and disordered eating. METHODS Thirty-five female adolescents with AN and 25 with BN were assessed at admission to inpatient treatment and at discharge. REE was measured using indirect calorimetry (DELTATRAC Metabolic Monitor). Expected REE was calculated using the Harris-Benedict equation. RESULTS An overestimation of expected versus measured REE was found for both patients with AN and BN, both at admission and discharge. Second, the differences between expected and measured REE were significantly less robust in BN versus AN. Third, REE before renourishing was lower in inpatients with AN versus BN. Fourth, the REE of patients with AN (both measured and expected) increased from admission to discharge, to a greater extent than expected solely from the increase in weight. The difference between admission and discharge expected and measured REE was significant also in patients with BN. DISCUSSION Our findings suggest that predicted and measured REE are different in both AN and BN, and that both expected and measured REE are not useful in the planning of renourishing programs in patients with AN.
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Affiliation(s)
- Brigitte Kochavi
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shiri Mendelowitsch
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Yaroslavsky
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Toledano
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Dalit Modan-Moses
- Pediatric Endocrinology Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shilton T, Enoch-Levy A, Giron Y, Yaroslavsky A, Amiaz R, Gothelf D, Weizman A, Stein D. A retrospective case series of electroconvulsive therapy in the management of comorbid depression and anorexia nervosa. Int J Eat Disord 2020; 53:210-218. [PMID: 31639233 DOI: 10.1002/eat.23181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/17/2019] [Accepted: 08/31/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) is common in anorexia nervosa (AN), associated with worse outcome and greater suicide risk. Electroconvulsive therapy (ECT) is highly effective in the treatment of MDD refractory to antidepressive treatment. We describe a case series of female adolescents with AN receiving ECT for MDD resistant to treatment and/or with severe suicide risk. METHOD We retrospectively analyzed the files of all 30 adolescent females hospitalized in our department because of AN between 1998 and 2017 and treated with ECT. Severity of eating disorder (ED) and depressive symptoms was retrospectively assessed using the Clinical Global Impression-Severity Scale. RESULTS Patients were severely depressed and suicidal on admission. All were resistant to antidepressants. A significant deterioration in depression, with severe suicidality, occurred from admission to pre-ECT, with concomitant improvement in ED symptoms and increase in body mass index (BMI). Significant improvement in depressive and ED symptoms and increase in BMI occurred following ECT, continuing to discharge. Adverse effects were mostly minimal. Fifty-three percentage of the patients were rehospitalized within the first year after ECT, mostly because of deterioration of depression and attempted suicide. Several years after discharge, 46.6% of the patients had no evidence of depression, suicidality, and ED-symptomatology, and another 23% had only evidence of ED symptomatology. DISCUSSION ECT is safe and well tolerated in AN with severe comorbid treatment resistant MDD and/or with increased suicide risk. Many AN patients undergoing ECT may be remitted at long-term follow-up.
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Affiliation(s)
- Tal Shilton
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yanai Giron
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Yaroslavsky
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Revital Amiaz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child and Adolescent Psychiatric Outpatient Service, Division of Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Rabin Campus, Petach Tiqva, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Department of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Modan-Moses D, Yaroslavsky A, Kochavi B, Toledano A, Segev S, Balawi F, Mitrany E, Stein D. Linear growth and final height characteristics in adolescent females with anorexia nervosa. PLoS One 2012; 7:e45504. [PMID: 23029058 PMCID: PMC3445517 DOI: 10.1371/journal.pone.0045504] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 08/21/2012] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Growth retardation is an established complication of anorexia nervosa (AN). However, findings concerning final height of AN patients are inconsistent. The aim of this study was to assess these phenomena in female adolescent inpatients with AN. METHODS We retrospectively studied all 211 female adolescent AN patients hospitalized in an inpatient eating disorders department from 1/1/1987 to 31/12/99. Height and weight were assessed at admission and thereafter routinely during hospitalization and follow-up. Final height was measured in 69 patients 2-10 years after discharge. Pre-morbid height data was available in 29 patients. RESULTS Patients' height standard deviation scores (SDS) on admission (-0.285±1.0) and discharge (-0.271±1.02) were significantly (p<0.001) lower than expected in normal adolescents. Patients admitted at age ≤13 years, or less than 1 year after menarche, were more severely growth-impaired than patients admitted at an older age, (p = 0.03). Final height SDS, available for 69 patients, was -0.258±1.04, significantly lower than expected in a normal population (p = 0.04), and was more severely compromised in patients who were admitted less than 1 year from their menarche. In a subgroup of 29 patients with complete growth data (pre-morbid, admission, discharge, and final adult height), the pre-morbid height SDS was not significantly different from the expected (-0.11±1.1), whereas heights at the other time points were significantly (p = 0.001) lower (-0.56±1.2, -0.52±1.2, and -0.6±1.2, respectively). CONCLUSIONS Our findings suggest that whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
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Stein D, Gross-Isseroff R, Besserglick R, Ziv A, Mayer G, Yaroslavsky A, Toledano A, Voet H, Weizman A, Hermesh H. Olfactory function and alternation learning in eating disorders. Eur Neuropsychopharmacol 2012; 22:615-24. [PMID: 22858418 DOI: 10.1016/j.euroneuro.2011.12.006] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/13/2011] [Accepted: 12/03/2011] [Indexed: 10/28/2022]
Abstract
Orbitofrontal dysfunction is a prominent feature of obsessive compulsive disorder (OCD). In the present study we assessed orbitofrontal functioning in eating disorders (EDs) which share many features with OCD. For this purpose we studied female adolescent inpatients with anorexia nervosa restricting type (n=40), anorexia nervosa binge/purge type (n=23), a normal weight group including patients with either bulimia nervosa or eating disorder not otherwise specified-purging type (n=33), and 20 non-ED control females. Patients were assessed at admission, and when achieving weight restoration and symptom stabilization at discharge, for depression, non-ED, and ED-related OC symptoms. Orbitofrontal functioning was assessed with an alternation learning task, and with a battery assessing olfactory threshold and discrimination. Control females were assessed once. ED patients of all subtypes performed better on olfactory threshold and discrimination, but not on alternation learning, in comparison to healthy controls. More favorable orbitofrontal functioning was associated with greater ED-related obsessionality. No changes were found in olfactory threshold and discrimination between acutely-ill and symptomatically-stabilized patients. The improvement shown in alternation learning from admission to discharge was suggested to reflect a learning effect rather than being an actual change. Our findings suggest that the better orbitofrontal functioning of ED patients in comparison to healthy controls may represent a core feature of the ED that is independent of malnutrition and deranged eating behaviors, but is associated with ED-related obsessionality.
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Affiliation(s)
- Daniel Stein
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Chambless LB, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC, Zhou T, Meng X, Xu B, Wei S, Chen X, De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS, Gonzalez JDSR, Alberto OV, Patricia HM, Chaichana K, Pendleton C, Chambless L, Nathan J, Camara-Quintana J, Li G, Harsh G, Thompson R, Lim M, Quinones-Hinojosa A, Oppenlander ME, Wolf A, Porter R, Nakaji P, Smith KA, Spetzler RF, Sanai N, Kim JH, Clark AJ, Jahangiri A, Sughrue ME, McDermott MW, Aghi MK, Chen C, Kasper E, Warnke P, Park CK, Lee SH, Song SW, Kim JW, Kim TM, Yamaguchi F, Omura T, Ten H, Ishii Y, Kojima T, Takahashi H, Teramoto A, Pereira EA, Livermore J, Ansorge O, Bojanic S, Meng X, Xu B, Chen X, Wei S, Zhou T, Tong H, Yu X, Zhou D, Hou Y, Zhou Z, Zhang J, Fabiano AJ, Rigual N, Munich S, Fenstermaker RA, Chen X, Meng X, Zhang J, Wang F, Zhao Y, Xu BN, Kim EH, Oh MC, Lee EJ, Kim SH, Kim YH, Kim CY, Kim YH, Han JH, Park CK, Kim SK, Paek SH, Wang KC, Kim DG, Jung HW, Chen X, Meng X, Wang F, Zhao Y, Xu BN, Krex D, Lindner C, Juratli T, Raue C, Schackert G, Valdes PA, Kim A, Leblond F, Conde OM, Harris BT, Paulsen KD, Wilson BC, Roberts DW, Krex D, Juratli T, Lindner C, Raue C, Schackert G, Occhiogrosso G, Cascardi P, Blagia M, De Tommasi A, Gelinas-Phaneuf N, Choudhury N, Al-Habib A, Cabral A, Nadeau E, Vincent M, Pazos V, Debergue P, DiRaddo R, Del Maestro RF, Guha-Thakurta N, Prabhu SS, Schulder M, Zavarella S, Nardi D, Schaffer S, Ruge MI, Grau S, Fuetsch M, Kickingereder P, Hamisch C, Treuer H, Voges J, Sturm V, Choy W, Yew A, Spasic M, Nagasawa D, Kim W, Yang I, Quigley MR, Hobbs J, Bhatia S, Cohen ZR, Shimon I, Hadani M, Carapella CM, Oppido PA, Vidiri A, Telera S, Pompili A, Villani V, Fabi A, Pace A, Cahill D, Wang M, Won M, Aldape K, Maywald R, Hegi M, Mehta M, Gilbert M, Sulman E, Vogelbaum M, Narayana A, Kunnakkat SD, Parker E, Gruber D, Gruber M, Knopp E, Zagzag D, Golfinos J, Dziurzynski K, Blas-Boria D, Suki D, Cahill D, Prabhu S, Puduvalli V, Levine N, Bloch O, Han SJ, Kaur G, Aghi MK, McDermott MW, Berger MS, Parsa AT, Quigley MR, Fukui O, Chew B, Bhatia S, DePowell JJ, Sanders-Taylor C, Guarnaschelli J, McPherson C, Sheth SA, Snuderl M, Kwon CS, Wirth D, Yaroslavsky A, Curry WT, Vogelbaum MA, Wang M, Hadjipanayis CG, Won M, Mehta MP, Gilbert MR, Megyesi JF, Macdonald D, Wang B, Pierre GHS, Hoover JM, Goerss SJ, Kaufmann TJ, Meyer FB, Parney IF, Guthikonda B, Thakur J, Khan I, Ahmed O, Shorter C, Wilson J, Welsh J, Cuellar H, Jeroudi M. SURGICAL THERAPIES. Neuro Oncol 2011; 13:iii154-iii163. [PMCID: PMC3222965 DOI: 10.1093/neuonc/nor164] [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: 12/04/2023] Open
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Nahshoni E, Yaroslavsky A, Varticovschi P, Weizman A, Stein D. Alterations in QT dispersion in the surface electrocardiogram of female adolescent inpatients diagnosed with bulimia nervosa. Compr Psychiatry 2010; 51:406-11. [PMID: 20579515 DOI: 10.1016/j.comppsych.2009.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 09/29/2009] [Accepted: 10/21/2009] [Indexed: 11/29/2022] Open
Abstract
Increased QT dispersion (QTd) reflects cardiac autonomic imbalance and indicates elevated risk for cardiac arrhythmias. In the present study, we assessed heart rate, QT and corrected QT intervals, and QTd in 20 acutely ill bulimia nervosa adolescent inpatients on admission and discharge. A significant decrease in QTd was found between admission and discharge (67 +/- 13 milliseconds vs 55 +/- 12 milliseconds, respectively; P = .0005). The decrease in QTd values correlated significantly with the decrease in the frequency of bingeing/purging behaviors (r = 0.51, P = .022). No significant correlations were found between the electrocardiographic indices and other clinical and laboratory measures. The elevated QTd in malnourished bulimia nervosa patients might indicate a cardiac autonomic imbalance that is most likely corrected after symptomatic improvement.
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Affiliation(s)
- Eitan Nahshoni
- Geha Mental Health Center, Beilinson Campus, Petah Tikva, Israel.
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Chan BP, Hui TY, Chan OCM, So KF, Lu W, Cheung KMC, Salomatina E, Yaroslavsky A. Photochemical cross-linking for collagen-based scaffolds: a study on optical properties, mechanical properties, stability, and hematocompatibility. ACTA ACUST UNITED AC 2007; 13:73-85. [PMID: 17518582 DOI: 10.1089/ten.2006.0004] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Collagen presents an attractive biomaterial for tissue engineering because of its excellent biocompatibility and negligible immunogenicity. However, some intrinsic features related to the mechanical stability and thrombogenicity limit its applications in orthopedic and vascular tissue engineering. Photochemical cross-linking is an emerging technique able to stabilize tissue grafts and improve the physicochemical properties of collagen-based structures. However, other important properties of collagen-based structures and the effect of processing parameters on these properties have not been explored. In this study, we aim to investigate the dose dependence of tensile and swelling properties on two parameters, namely, laser energy fluence and rose Bengal photosensitizer concentration. We also study the compression properties using cyclic compression test, long-term stability using subcutaneous implantation, and hematocompatibility using platelets adhesion test, of cross-linked collagen structures. Moreover, because limited optical penetration in turbid media is the major obstacle for light-based techniques, we also characterize the optical properties, which partially determine the effective optical penetration depth in collagen gel samples, during photochemical cross-linking. Laser energy fluence and rose Bengal concentration are important parameters affecting the cross-linking efficiency, which was characterized as the mechanical and the swelling properties, in a dose-dependent manner. Under the experimental conditions in this study, the peak fluence was 12.5 J/cm2 and the minimal rose Bengal concentration for effective cross-linking was >0.00008% (0.786 micromol). Photochemical cross-linking also enhanced the compression strength and long-term stability of collagen structures without compromising the tissue compatibility. Furthermore, photochemical cross-linking reduced platelet adhesion and abolished fibrin mesh formation, thereby improving the hematocompatibility of collagen structures. These results suggest the feasibility of using the photochemically cross-linked collagen structures for orthopedic and vascular tissue engineering. Finally, the effective optical penetration depth in collagen gel samples is wavelength and rose Bengal concentration dependent, and was approximately 12 mm at 514 nm at 0.001% (9.825 micromol), the rose Bengal concentration mostly used in this study.
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Affiliation(s)
- B P Chan
- Medical Engineering Program, Department of Mechanical Engineering, University of Hong Kong, Hong Kong Special Administrative Region, China, and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA.
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Modan-Moses D, Stein D, Pariente C, Yaroslavsky A, Ram A, Faigin M, Loewenthal R, Yissachar E, Hemi R, Kanety H. Modulation of adiponectin and leptin during refeeding of female anorexia nervosa patients. J Clin Endocrinol Metab 2007; 92:1843-7. [PMID: 17327386 DOI: 10.1210/jc.2006-1683] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [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: 02/12/2023]
Abstract
CONTEXT Several studies assessed adiponectin levels in anorexia nervosa (AN) patients, however, data regarding the dynamics of changes in adiponectin levels during refeeding of these patients is limited and contradicting. OBJECTIVE Our objective was to assess adiponectin levels and the distribution of its different isoforms in AN patients before and after long-term refeeding, and to relate them to alterations in body mass index, leptin, insulin sensitivity, and additional endocrine parameters. DESIGN, SETTING, AND PARTICIPANTS We conducted a longitudinal controlled study of 38 female adolescent malnourished AN inpatients, with 13 young, lean, healthy women serving as controls. Blood samples were obtained upon admission and thereafter at 1, 3, and 5 months (at target weight). MAIN OUTCOME MEASURES Changes in body mass index, leptin, adiponectin, insulin sensitivity, and adiponectin multimeric forms were measured. RESULTS At admission, leptin levels of AN patients were significantly lower, whereas insulin sensitivity (assessed by homeostasis model assessment-insulin resistance), adiponectin levels, and the ratio of high molecular weight (HMW) adiponectin to total adiponectin were significantly higher compared with controls. During weight recovery, leptin levels and homeostasis model assessment-insulin resistance increased significantly, whereas adiponectin and HMW adiponectin/total adiponectin ratio decreased significantly, to levels similar to controls. An initial increase in adiponectin levels was observed after 1 month of refeeding. There was no correlation between adiponectin and either T(4) or cortisol levels. CONCLUSIONS Our study demonstrates hyperadiponectinemia, increased adiponectin HMW isoform, and increased insulin sensitivity in adolescent AN female patients and reversal of these findings with weight rehabilitation. We hypothesize that increased adiponectin levels may have a protective role in maintaining energy homeostasis during extreme malnourishment.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology Unit, Division of Pediatrics, Chaim Sheba Medical Center, Tel-Hashomer, 52621 Israel.
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Nahshoni E, Weizman A, Yaroslavsky A, Toledano A, Sulkes J, Stein D. Alterations in QT dispersion in the surface electrocardiogram of female adolescents diagnosed with restricting-type anorexia nervosa. J Psychosom Res 2007; 62:469-72. [PMID: 17383499 DOI: 10.1016/j.jpsychores.2006.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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] [Received: 03/31/2006] [Revised: 09/25/2006] [Accepted: 10/31/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE QT dispersion (QTd), defined as the difference between the longest interval and the shortest interval in the 12-lead electrocardiogram (ECG), is a measure of myocardial repolarization inhomogeneity. We assessed QTd in malnourished anorexia nervosa (AN) inpatients and following weight restoration. METHODS QTd analysis, anthropometric evaluations, and laboratory tests were carried out in 30 malnourished female adolescent AN restricting-type (AN-R) inpatients and following weight restoration. RESULTS A significant increase was found in weight/height ratio and body mass index from malnourished stage to weight restoration, paralleled by a significant decrease in QTd (70+/-16 vs. 47+/-16 ms; P<.0001). No correlations were found between ECG indices and anthropometric and laboratory measures. CONCLUSION Elevated QTd in malnourished AN-R inpatients may indicate possible cardiac autonomic imbalance and/or myocardial damage, likely corrected following weight restoration.
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Affiliation(s)
- Eitan Nahshoni
- Geha Mental Health Center, Beilinson Campus, Petah Tikva, Israel.
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Chan B, Hui T, Chan O, So KF, Lu W, Cheung K, Salomatina E, Yaroslavsky A. Photochemical Cross-Linking for Collagen-Based Scaffolds: A Study on Optical Properties, Mechanical Properties, Stability, and Hematocompatibility. ACTA ACUST UNITED AC 2006. [DOI: 10.1089/ten.2006.12.ft-280] [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: 11/13/2022]
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Modan-Moses D, Yaroslavsky A, Novikov I, Segev S, Toledano A, Miterany E, Stein D. Stunting of growth as a major feature of anorexia nervosa in male adolescents. Pediatrics 2003; 111:270-6. [PMID: 12563050 DOI: 10.1542/peds.111.2.270] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [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: 11/24/2022] Open
Abstract
OBJECTIVE To assess growth retardation in male adolescent patients who have a diagnosis of anorexia nervosa (AN) and the effect of weight restoration on catch-up growth. METHODS Medical charts of all male adolescent AN patients (n = 12) who were admitted to the Pediatric Psychosomatic Department at the Sheba Medical Center from January 1, 1994, to December 31, 1998, were reviewed. Height and weight measurements were obtained before the onset of AN, at admission, and thereafter routinely during hospitalization and follow-up. RESULTS Eleven patients exhibited growth retardation during the course of their illness, as evident in a decrease in their height standard deviation score (SDS). The mean height SDS at the time of admission (-0.81 +/- 0.93) was significantly lower than the premorbid SDS (-0.21 +/- 0.91). Weight restoration resulted in accelerated linear growth (up to 2 cm/mo) in all patients. Positive weight gain (weight gain rate >1 kg/y) was associated with a mean height gain of 6.97 +/- 6.48 cm/y, whereas weight loss or failure to gain weight (weight gain rate <or=1 kg/y) was associated with a mean of 2.7 +/- 3.9 cm/y. This between-group difference was highly significant. Complete catch-up growth was not achieved in 9 of 12 patients. There was a trend for the mean adult final height SDS (-0.52 +/- 0.84) to be higher than the admission height SDS but lower than both the premorbid height SDS and the midparental target height SDS (-0.21 +/- 0.79). CONCLUSIONS Linear growth retardation was a prominent feature of AN in our sample of male adolescent patients, preceding, in some cases, the reported detection of the eating disorder. Weight restoration, particularly when target weight is based on the premorbid height percentile, may be associated with significant catch-up growth, but complete catch-up growth may not be achieved.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology Service, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Rosenfeld A, Caplan G, Yaroslavsky A, Jacobowitz J, Yuval Y, LeBow H. Adaptation of children of parents suffering from cancer: A preliminary study of a new field for primary prevention research. J Prim Prev 1983; 3:244-50. [DOI: 10.1007/bf01325407] [Citation(s) in RCA: 20] [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: 11/30/2022]
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