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Hranjec T, Mayhew M, Rogers B, Solomon R, Hurst D, Estreicher M, Augusten A, Nunez A, Green M, Malhotra S, Katz R, Rosenthal A, Hennessy S, Pepe P, Sawyer R, Arenas J. Diagnosis and treatment of coagulopathy using thromboelastography with platelet mapping is associated with decreased risk of pulmonary failure in COVID-19 patients. Blood Coagul Fibrinolysis 2023; 34:508-516. [PMID: 37831624 DOI: 10.1097/mbc.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Treatment of coronavirus disease 2019 (COVID-19) patients may require antithrombotic and/or anti-inflammatory medications. We hypothesized that individualized anticoagulant (AC) management, based on diagnosis of coagulopathy using thromboelastography with platelet mapping (TEG-PM), would decrease the frequency of pulmonary failure (PF) requiring mechanical ventilation (MV), mitigate thrombotic and hemorrhagic events, and, in-turn, reduce mortality. METHODS Hospital-admitted COVID-19 patients, age 18 or older, with escalating oxygen requirements were included. Prospective and supplemental retrospective chart reviews were conducted during a 2-month period. Patients were stratified into two groups based on clinician-administered AC treatment: TEG-PM guided vs. non-TEG guided. RESULTS Highly-elevated inflammatory markers (D-dimer, C-reactive protein, ferritin) were associated with poor prognosis but did not distinguish coagulopathic from noncoagulopathic patients. TEG-guided AC treatment was used in 145 patients vs. 227 treated without TEG-PM guidance. When managed by TEG-PM, patients had decreased frequency of PF requiring MV (45/145 [31%] vs. 152/227 [66.9%], P < 0.0001), fewer thrombotic events (2[1.4%] vs. 39[17.2%], P = 0.0019) and fewer hemorrhagic events (6[4.1%] vs. 24[10.7%], P = 0.0240), and had markedly reduced mortality (43[29.7%] vs. 142[62.6%], P < 0.0001). Platelet hyperactivity, indicating the need for antiplatelet medications, was identified in 75% of TEG-PM patients. When adjusted for confounders, empiric, indiscriminate AC treatment (not guided by TEG-PM) was shown to be an associated risk factor for PF requiring MV, while TEG-PM guided management was associated with a protective effect (odds ratio = 0.18, 95% confidence interval 0.08-0.4). CONCLUSIONS Following COVID-19 diagnosis, AC therapies based on diagnosis of coagulopathy using TEG-PM were associated with significantly less respiratory decompensation, fewer thrombotic and hemorrhagic complications, and improved likelihood of survival.
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Affiliation(s)
- Tjasa Hranjec
- Department of Surgery, Bronson Methodist Hospital
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
- Department of Surgery, Memorial Regional Hospital, Hollywood
| | - Mackenzie Mayhew
- Florida International University, Miami, Florida
- University of Virginia, Charlottesville, Virginia
| | | | - Rachele Solomon
- Department of Surgery, Memorial Regional Hospital, Hollywood
| | | | | | | | - Aaron Nunez
- Department of Medicine, Memorial Regional Hospital, Hollywood, Florida
| | - Melissa Green
- Department of Medicine, Memorial Regional Hospital, Hollywood, Florida
| | - Shivali Malhotra
- Department of Medicine, Memorial Regional Hospital, Hollywood, Florida
| | | | | | - Sara Hennessy
- Department of Surgery, University of Texas Southwestern Medical Center
| | - Paul Pepe
- Metropolitan Emergency Medical Services, Medical Directors Coalition Global Hdqtrs, Dallas, Texas, USA
| | - Robert Sawyer
- Department of Surgery, Bronson Methodist Hospital
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Juan Arenas
- Department of Surgery, Memorial Regional Hospital, Hollywood
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Lütt A, Tsamitros N, Wolbers T, Rosenthal A, Bröcker AL, Schöneck R, Bermpohl F, Heinz A, Beck A, Gutwinski S. An explorative single-arm clinical study to assess craving in patients with alcohol use disorder using Virtual Reality exposure (CRAVE)-study protocol. BMC Psychiatry 2023; 23:839. [PMID: 37964300 PMCID: PMC10647047 DOI: 10.1186/s12888-023-05346-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) belongs to the most burdensome clinical disorders worldwide. Current treatment approaches yield unsatisfactory long-term effects with relapse rates up to 85%. Craving for alcohol is a major predictor for relapse and can be intentionally induced via cue exposure in real life as well as in Virtual Reality (VR). The induction and habituation of craving via conditioned cues as well as extinction learning is used in Cue Exposure Therapy (CET), a long-known but rarely used strategy in Cognitive Behavioral Therapy (CBT) of AUD. VR scenarios with alcohol related cues offer several advantages over real life scenarios and are within the focus of current efforts to develop new treatment options. As a first step, we aim to analyze if the VR scenarios elicit a transient change in craving levels and if this is measurable via subjective and psychophysiological parameters. METHODS A single-arm clinical study will be conducted including n = 60 patients with AUD. Data on severity of AUD and craving, comorbidities, demographics, side effects and the feeling of presence in VR will be assessed. Patients will use a head-mounted display (HMD) to immerse themselves into three different scenarios (neutral vs. two target situations: a living room and a bar) while heart rate, heart rate variability, pupillometry and electrodermal activity will be measured continuously. Subjective craving levels will be assessed before, during and after the VR session. DISCUSSION Results of this study will yield insight into the induction of alcohol craving in VR cue exposure paradigms and its measurement via subjective and psychophysiological parameters. This might be an important step in the development of innovative therapeutic approaches in the treatment of patients with AUD. TRIAL REGISTRATION This study was approved by the Charité-Universitätsmedizin Berlin Institutional Review Board (EA1/190/22, 23.05.2023). It was registered on ClinicalTrials.gov (NCT05861843).
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Affiliation(s)
- A Lütt
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany.
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany.
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, 10117, Berlin, Germany.
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany.
| | - N Tsamitros
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - T Wolbers
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
| | - A Rosenthal
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - A L Bröcker
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - R Schöneck
- Salus Clinic Lindow, 16835, Lindow, Germany
| | - F Bermpohl
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - A Heinz
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany
| | - A Beck
- Faculty of Health, Health and Medical University, 14471, Potsdam, Germany
| | - S Gutwinski
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
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Saifi O, Lester SC, Rule WG, Breen W, Stish BJ, Rosenthal A, Munoz J, Lin Y, Johnston P, Ansell SM, Paludo J, Khurana A, Bisneto JV, Wang Y, Iqbal M, Moustafa MA, Murthy HS, Kharfan-Dabaja M, Peterson JL, Hoppe BS. Consolidative Radiotherapy for Residual PET-Avid Disease on Day +30 Post CAR T-Cell Therapy in Non-Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2023; 117:S52. [PMID: 37784518 DOI: 10.1016/j.ijrobp.2023.06.335] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Up to30% of non-Hodgkin lymphoma (NHL) patients achieve a partial response (PR) to anti-CD19 Chimeric Antigen Receptor T-cell Therapy (CART) on day +30. Most PR patients relapse and only 30% achieve spontaneous complete response (CR) without additional therapies. This study is the first to report on the role of consolidative radiotherapy (cRT) for PR PET-avid disease on day +30 post-CART in NHL. MATERIALS/METHODS Aretrospective review across 3 institutions from 2018 to 2022 identified 60 patients with B-cell NHL who received CART and achieved PR (Deauville 4-5) with <5 PET-avid disease sites on day +30. Progression-free survival (PFS) was defined from CART infusion to any disease progression. Overall survival (OS) was defined from CART infusion to death. Local relapse-free survival (LRFS), calculated based on the total number of PR sites, was defined from CART infusion to local relapse (LR) in the PR site identified on day +30. cRT was defined as comprehensive (compRT) - treated all PR PET-avid sites - or focal (focRT). RESULTS Followingday +30 PET scan, 45 PR patients were observed and 15 received cRT. Only one patient received consolidative systemic therapy and belonged to the cRT group. Prior to CART, bridging RT was given to 13 patients (9 in observation group and 4 in cRT group). There were no significant differences in the pre-CART and day +30 baseline characteristics, including the median size and SUVmax of the PR sites, between the two groups. However, the median number of PR sites on day +30 was higher in the cRT group (2 [range 1-3] vs 1 [range 1-3], p = 0.003). The median equivalent 2 Gy dose was 39.1 (Interquartile range 36.8-41) Gy, and the most common cRT regimen was 37.5 Gy in 15 fractions. The median follow-up was 21 months. Among the observed patients, 15 (33%) achieved spontaneous CR, and 27 (60%) experienced disease progression with all relapses involving the initial PR sites. Among patients who received cRT, 10 (67%) achieved CR, and 3 (20%) had disease progression with no relapses in the radiated PR sites. None of the 10 cRT patients achieving CR relapsed or required subsequent therapies. The 2-year PFS was 80% and 37% (p = 0.012) and the 2-year OS was 78% and 43% (p = 0.12) in the cRT and observation groups, respectively. Patients consolidated with compRT (n = 12) had superior 2-year PFS (92% vs 37%, p = 0.003) and 2-year OS (86% vs 43%, p = 0.048) compared to observed or focRT patients (n = 48). There were no grade 3+ RT-related toxicities. A total of 90 PR sites were identified; 64 were observed and 26 received cRT. Fourteen (22%) observed PR sites achieved spontaneous sustained CR and 42 (66%) experienced LR. Twenty-four (92%) PR sites consolidated with cRT achieved sustained CR and none experienced LR. The 2-year LRFS was 100% in the cRT sites and 31% in the observed sites (p<0.001). CONCLUSION NHL patients who achieve PR by PET to CART are at high risk of local progression. cRT for residual PET-avid disease on day +30 post-CART appears to alter the pattern of relapse and improve LRFS and PFS.
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Affiliation(s)
- O Saifi
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - S C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - W Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - B J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Rosenthal
- Division of Hematology, Mayo Clinic, Phoenix, AZ
| | - J Munoz
- Division of Hematology, Mayo Clinic, Phoenix, AZ
| | - Y Lin
- Division of Experimental Pathology, Mayo Clinic, Rochester, MN; Division of Hematology, Mayo Clinic, Rochester, MN
| | - P Johnston
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - J Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - A Khurana
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Y Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - M Iqbal
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - H S Murthy
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - J L Peterson
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - B S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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Saifi O, Rule WG, Lester SC, Laack NN, Breen W, Rosenthal A, Ansell SM, Habermann TM, Villasboas Bisneto J, Iqbal M, Alhaj Moustafa M, Tun H, Kharfan-Dabaja M, Peterson JL, Hoppe BS. The Role of Radiation Therapy in the Management of Gray Zone Lymphoma. Int J Radiat Oncol Biol Phys 2023; 117:e484-e485. [PMID: 37785532 DOI: 10.1016/j.ijrobp.2023.06.1711] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Gray zone lymphoma (GZL) is a relatively rare disease predominantly affecting young adults with purportedly poor outcomes with current treatment approaches. The role of radiation therapy (RT) in the management of GZL is not well established. This is the largest study to report on the outcomes of GZL patients treated with and without RT. MATERIALS/METHODS A retrospective review of 30 patients with GZL treated across 3 institutions from 2009 to 2021 was performed. Event-free survival (EFS) was defined from initiation of frontline chemotherapy (CHT) to disease progression/relapse, initiation of salvage therapy, or death. Local control (LC) was defined from RT start date to in-field recurrence. RESULTS The median age was 32 (range: 18-86) years, and 16 (53%) patients had early stage (I-II) disease. Bulky mediastinal disease was present in 63% of patients, and the median tumor diameter was 10 (range: 1.5-18) cm. Patients received ABVD (20%), RCHOP (33%), or REPOCH (47%) as frontline CHT. Among 25 patients with interim PET/CT scan, there were 6 rapid early responders and 14 slow early responders (SER), with 2-year EFS of 33% and 24%, respectively (p = 0.13). After the completion of CHT, 15 (50%) patients achieved complete response (CR) and 10 (33%) achieved partial response (PR), with 2-year EFS of 46% and 10%, respectively (p = 0.004). RT was given to 9 patients in CR (n = 3) or in PR (n = 6). The median RT dose was 36 (30.6-48.6) Gy, at 1.8-2 Gy/fraction. Those receiving RT had bulkier disease at diagnosis (p = 0.049) and lower rates of CR following CHT (p = 0.03). After RT, 3/6 (50%) PR patients converted to CR. At a median follow-up of 4 years, the 2-year EFS was 26% for all patients, 33% for RT and 23% for noRT (p = 0.44). Among patients who did not receive upfront RT and experienced progression (n = 17), 16 (94%) relapsed in pre-existing sites. The 5-year OS was 80% for all patients, 88% for RT and 78% for no RT (p = 0.63). Patients who achieved PR to CHT and received RT had better 2-year EFS (17% vs 0%, p = 0.007) compared to patients who did not receive RT. Similarly, patients with SER who received RT had superior 2-year EFS (33% vs 13%, p = 0.038). Patients with bulky mediastinal disease had a 2-year EFS of 43% with RT and 11% without RT (p = 0.08). After 1st line treatment, 22 (73%) patients relapsed and 18 were successfully salvaged with a sustained CR. The most common salvage regimen involved high dose CHT followed by hematopoietic cell transplantation (HCT) (n = 15). RT was given for 7 patients in the relapsed/refractory setting (consolidative peri-HCT n = 4; definitive salvage n = 3) and 5 (71%) achieved a sustained CR. Among the 16 patients who received RT in the upfront (n = 9) or salvage (n = 7) setting, 3 patients experienced in-field recurrence translating to 2-year LC of 79%. CONCLUSION GZL patients have high risk of relapse and maximal upfront combined modality therapy should be considered. RT provides good local control and improves EFS particularly for SER, PR, and bulky mediastinal disease.
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Affiliation(s)
- O Saifi
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - W G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - S C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Rosenthal
- Division of Hematology, Mayo Clinic, Phoenix, AZ
| | - S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - M Iqbal
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - H Tun
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - J L Peterson
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - B S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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Rosenthal A, Chen J. Dimensions of food texture: A conceptual discussion. J Texture Stud 2023; 54:449-455. [PMID: 37382187 DOI: 10.1111/jtxs.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 06/04/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
Food texture is a collective term for all texture-related features of a food product. A comprehensive description of food texture is therefore practically challenging due to too many parameters that are associated simultaneously with the food. Using every day, non-technical (layman's) language, we attempt in this work to rationalize the different dimensions that contribute to the texture of foods, and we explain the rheological reasons behind the concept. For solid foods, three dimensions are identified being the "hard-soft," "strong-weak," and "brittle-plastic." For liquid foods, three further dimensions are suggested, being "elastic-viscous," "thick-thin," and "shear thinning-shear thickening." As these dimensions are bipolar, for foods where any of the dimensions are not relevant, we conceive that dimension takes on a zero value, aligning at the center of the scale.
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Affiliation(s)
- Andrew Rosenthal
- School of Bioscience, University of Nottingham, Sutton Bonington, UK
| | - Jianshe Chen
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
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Parreco JP, Avila A, Pruett R, Romero DC, Solomon R, Buicko JL, Rosenthal A, Carrillo EH. Financial Toxicity in Emergency General Surgery: Novel Propensity-Matched Outcome Comparison. J Am Coll Surg 2023; 236:775-780. [PMID: 36728000 DOI: 10.1097/xcs.0000000000000571] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Financial toxicity describes the harmful effect of individual treatment costs and fiscal burdens that have a compounding negative impact on outcomes in surgery. While this phenomenon has been widely studied in surgical oncology, the purpose of this study was to perform a novel exploration of the impact of financial toxicity in emergency general surgery (EGS) patients throughout the US. STUDY DESIGN The Nationwide Readmissions Database for January and February 2018 was queried for all EGS patients aged 18 to 65 years. One-to-one propensity matching was performed with and without risk for financial toxicity. The primary outcome was mortality, and the secondary outcomes were venous thromboembolism (VTE), prolonged length of stay (LOS), and readmission within 30 days. RESULTS There were 24,154 EGS patients propensity matched. The mortality rate was 0.2% (n = 39), and the rate of VTE was 0.5% (n = 113). With financial toxicity, there was no statistically significant difference for mortality (p = 0.08) or VTE (p = 0.30). The rate of prolonged LOS was 6.2% (n = 824), and the risk was increased with financial toxicity (risk ratio 1.24 [1.12 to 1.37]; p < 0.001). The readmission rate was 7.0% (n = 926), and the risk with financial toxicity was increased (risk ratio 1.21 [1.10 to 1.33]; p < 0.001). The mean count of comorbidities per patient per admission during readmission within 1 year with financial toxicity was 2.1 ± 1.9 versus 1.8 ± 1.7 without (p < 0.001). CONCLUSIONS Despite little difference in the rate of mortality or VTE, EGS patients at risk for financial toxicity have an increased risk of readmission and longer LOS. Fewer comorbidities were identified at index admission than during readmission in patients at risk for financial toxicity. Future studies aimed at reducing this compounding effect of financial toxicity and identifying missed comorbidities have the potential to improve EGS outcomes.
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Affiliation(s)
- Joshua P Parreco
- From the Trauma Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL (Parreco, Solomon, Rosenthal, Carrillo)
| | - Azalia Avila
- the General Surgery Residency, Memorial Healthcare System, Hollywood, FL (Avila, Pruett, Romero)
| | - Rachel Pruett
- the General Surgery Residency, Memorial Healthcare System, Hollywood, FL (Avila, Pruett, Romero)
| | - Dino C Romero
- the General Surgery Residency, Memorial Healthcare System, Hollywood, FL (Avila, Pruett, Romero)
| | - Rachele Solomon
- From the Trauma Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL (Parreco, Solomon, Rosenthal, Carrillo)
| | - Jessica L Buicko
- the Endocrine, Breast, and General Surgery, Florida Atlantic University, Boynton Beach, FL (Buicko)
| | - Andrew Rosenthal
- From the Trauma Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL (Parreco, Solomon, Rosenthal, Carrillo)
| | - Eddy H Carrillo
- From the Trauma Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL (Parreco, Solomon, Rosenthal, Carrillo)
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Vakil DP, Shumway MC, Spector CL, Carrillo EH, Rosenthal A. Low Threshold for Laparoscopic Exploration in Dementia Patients With Unexplained Abdominal Pain and Risk Factors for Acute Mesenteric Ischemia. Am Surg 2023. [PMID: 36867159 DOI: 10.1177/00031348231161719] [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: 03/04/2023]
Abstract
Acute mesenteric ischemia (AMI) is associated with a high mortality and morbidity. There are limited studies on the presentation and management of elderly dementia patients with AMI. The following case of an 88-year-old female with dementia presenting with AMI highlights the challenges in the care of elderly dementia patients with AMI, the importance of identifying risk factors and hallmarks of acute mesenteric ischemia early in the clinical course, and suggests that aggressive workup with diagnostic laparoscopy is crucial to timely diagnosis and effective care.
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Affiliation(s)
- Deep P Vakil
- Division of Trauma and Acute Care Surgery, 3932Memorial Regional Hospital, Hollywood, FL, USA
| | - Megan C Shumway
- Division of Trauma and Acute Care Surgery, 3932Memorial Regional Hospital, Hollywood, FL, USA
| | - Chelsea L Spector
- Division of Trauma and Acute Care Surgery, 3932Memorial Regional Hospital, Hollywood, FL, USA
| | - Eddy H Carrillo
- Division of Trauma and Acute Care Surgery, 3932Memorial Regional Hospital, Hollywood, FL, USA
| | - Andrew Rosenthal
- Division of Trauma and Acute Care Surgery, 3932Memorial Regional Hospital, Hollywood, FL, USA
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Hernandez J, Spector CL, Quintero LA, Shatawi Z, Rosenthal A, Curcio G, Buicko JL, Parreco JP. Comparing Severely Injured Trauma Patients Admitted to Investor-Owned versus Public and Not-For-Profit Hospitals Reveals Opportunities for Improvement in the US. Am Surg 2023:31348231160818. [PMID: 36862674 DOI: 10.1177/00031348231160818] [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: 03/03/2023]
Abstract
BACKGROUND Non-elderly trauma patients represent the largest portion of preventable years of life loss in the US. The purpose of this study was to compare outcomes in patients admitted to investor-owned vs public and not-for-profit hospitals across the US. MATERIAL AND METHODS The Nationwide Readmissions Database 2018 was queried for trauma patients with an Injury Severity Score greater than 15 and age 18-65 years. The primary outcome was mortality; secondary outcomes were prolonged length of stay (LOS) greater than 30 days, readmission within 30 days, and readmission to a different hospital. Patients admitted to investor-owned hospitals were compared to public and not-for-profit hospitals. Univariable analysis was performed using chi-squared tests. Multivariable logistic regression was performed for each outcome. RESULTS 157 945 patients were included with 11.0% (n = 17 346) admitted to investor-owned hospitals. The overall mortality rate and prolonged LOS were similar for both groups. The overall readmission rate was 9.2% (n = 13 895), with the rate in investor-owned hospitals at 10.5% (n = 1,739, P < .001). Multivariable logistic regression revealed investor-owned hospitals had an increased risk of readmission (OR 1.2 [1.1-1.3] P < .001) and readmission to a different hospital (OR 1.3 [1.2-1.5] P < .001). DISCUSSION Severely injured trauma patients have similar rates of mortality and prolonged length of stay in investor-owned vs public and not-for-profit hospitals. However, patients admitted to investor-owned hospitals have an increased risk of readmission and readmission to different hospitals. Efforts to improve outcomes after trauma must consider hospital ownership and readmission to different hospitals.
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Affiliation(s)
- Jennifer Hernandez
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Chelsea L Spector
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Luis A Quintero
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Zaineb Shatawi
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Andrew Rosenthal
- Trauma Critical Care Surgery, 3932Florida Atlantic University, Hollywood, FL, USA
| | - Gary Curcio
- Trauma Critical Care Surgery, 7831University of South Florida, Fort Pierce, FL, USA
| | - Jessica L Buicko
- Endocrine, Breast, and General Surgery, 306688Florida Atlantic University, Boynton Beach, FL, USA
| | - Joshua P Parreco
- Trauma Critical Care Surgery, 3932Florida Atlantic University, Hollywood, FL, USA
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Spector CL, Hernandez J, Shatawi Z, Quintero LA, Rosenthal A, Parreco JP, Buicko JL. Comparing Payments to Surgeons From Drug and Medical Device Corporations Reveals Inequalities Between Genders and Specialties. Am Surg 2023:31348231160834. [PMID: 36852997 DOI: 10.1177/00031348231160834] [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: 03/01/2023]
Abstract
INTRODUCTION Maintaining trust in the patient-doctor relationship requires transparency in the details of the financial relationships between physicians and drug and medical device corporations. These details are publicly available through the Open Payments database, and patients are encouraged to ask surgeons to interpret their implications. The purpose of this study was to better equip surgeons in responding to these inquiries and to compare the distribution of these payments by gender and specialty. METHODS The 2021 Open Payments dataset was searched for all payments to surgeons from the 14 different specialties recognized by the American College of Surgeons. The total payments per surgeon were compared by calculating the mean and median payments. The Gini index, a measure of income inequality, was also calculated for each specialty. RESULTS There were 96 724 surgeons who received over $755 million in payments from drug and medical device companies. There were 72 245 (74.7%) men and 24 479 (25.3%) women. The total amount of payments to men was $712 million (94.2%) and for women it was $44 million (5.8%). The overall Gini index was .9508. The specialty with the highest Gini index was pediatric surgery (.9844) and the lowest was cardiothoracic surgery (.8656). DISCUSSION Male surgeons received disproportionately higher payments from drug and device corporations than female surgeons. Surgeons should be aware of their own standing within the Open Payments database in order to respond appropriately to patient inquiries.
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Affiliation(s)
- Chelsea L Spector
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Jennifer Hernandez
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Zaineb Shatawi
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Luis A Quintero
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Andrew Rosenthal
- Trauma Critical Care Surgery, 1782Florida Atlantic University, Hollywood, FL, USA
| | - Joshua P Parreco
- Trauma Critical Care Surgery, 1782Florida Atlantic University, Hollywood, FL, USA
| | - Jessica L Buicko
- Endocrine, Breast, and General Surgery, 1782Florida Atlantic University, Boynton Beach, FL, USA
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Abdelhameed S, Samudio A, Rosenthal A, Davila H. Quantifying pubocervical fibromuscularis elasticity under normal and prolapse conditions by shear wave elastography and comparison with urodynamics findings. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00105-7] [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: 02/12/2023]
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11
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Flores J, Moriarty A, Lizette F, Lang A, Rosenthal A, Papadopoulos K, Beeram M, Patnaik A, Rasco D, DeBerry B, Elmi M, Drengler R, Hernandez T, Sharma M, Lakhani N, Smith L, Moreno V, Calvo E, Garcia-Foncillas J, Wick M. Identification and molecular characterization of invasive lobular breast cancer models in a panel of 180 breast XPDX models. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01121-2] [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: 11/03/2022]
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12
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Levin NJ, Ghorishi AR, Charnowitz N, Rosenthal A, Ditchek J. Pneumothorax in the Setting of Spinal Surgery: A Case Report and Review of the Literature. Cureus 2022; 14:e26743. [PMID: 35967152 PMCID: PMC9363688 DOI: 10.7759/cureus.26743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
The purpose of this paper is to review the occurrence and management of a tension pneumothorax, which was exacerbated status post posterior spinal surgery. A retrospective review of intraoperative reports, imaging, and pertinent medical records was conducted for a patient who underwent posterior spinal surgery with a tiny apical pneumothorax, which subsequently developed into a major pneumothorax. The clinical signs imperative to recognition and prompt treatment are discussed. Our case report demonstrates that the unrecognized disruption of the pleural cavity during posterior spinal surgery caused the exacerbation of the patient's bilateral pneumothoraces. The patient was successfully treated with finger thoracostomy and chest tube insertion. In conclusion, posterior spinal surgery is an invasive procedure with the potential for serious complications such as the exacerbation of a previous non-surgical pneumothorax. A low index of suspicion is imperative due to the potentially lethal nature of pneumothoraces. Vital signs, pulmonary exam findings, portable radiography, and sonography equipment are all invaluable to the accurate diagnosis and early intervention of patients with pneumothoraces.
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Adriaenssens T, Van Vaerenbergh I, Reis M, Van Landuyt L, Verheyen G, Debrucker M, Camus M, Platteau P, De Vos M, Coucke W, Vanhecke E, Rosenthal A, Smitz J. P-251 Cumulus cell analysis as a non-invasive oocyte selection strategy to reduce the number of oocytes/embryos cultured and increase pregnancy rates. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.241] [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: 11/12/2022] Open
Abstract
Abstract
Study question
Can non-invasive gene expression analysis of cumulus cells (CC) improve efficiency in ART by prioritizing oocytes for further culture and fresh single embryo transfer?
Summary answer
CC analysis can be used for the selective processing of oocytes. This may reduce culture work and improve the outcome in ICSI elective SETs (eSET).
What is known already
In an interventional, blinded, prospective cohort study (Van Vaerenbergh et al. 2021), 113 patients underwent a fresh Day3 eSET with embryos ranked and transferred based on morphology and CC gene expression (Aurora Test), while 520 control patients underwent a Day3 eSET without the Aurora Test. This resulted in a significant higher clinical pregnancy of 61% in the patients with eSET based on CC ranking applied on good morphology embryos, compared to 29% in the controls with eSET based on embryo morphology only. Live birth rate was also significantly increased, while time-to-pregnancy was significantly reduced with 3 transfer cycles.
Study design, size, duration
In a retrospective analysis, in a subset of patients with at least 6 growing follicles and at least five 2PN oocytes (n = 80), it was investigated whether the Aurora Test, used to select transferrable Day3-embryos, could also be applied to select oocytes on Day0/1. The effect of processing only the three highest ranked oocytes (based on the Aurora Test) on embryo development and clinical pregnancy was studied compared to processing all oocytes.
Participants/materials, setting, methods
Patients included in this single centre study had their first or second GnRH-antagonist ICSI cycle, were younger than 40y, had normal BMI, were stimulated with HP-hMG and scheduled for Day3 eSET. Two-sided statistical analysis (p < 0,05) was performed between a strategy of processing only the top 3 Aurora ranked oocytes, according to CC gene expression, and a strategy of processing all available oocytes.
Main results and the role of chance
On average, 8 MII oocytes were obtained per patient and the average fertilization rate was 83%. In total, 407 good quality embryos (GQE) on Day3 were generated from these 80 patients when utilising all 639 oocytes. Processing the three top-ranked oocytes only (240/639 oocytes) would have reduced the number of embryos to 169 GQE and would have resulted in 2.1 GQE on average on Day3 per patient; 75/80 (94%) patients would have had a fresh Day3 transfer resulting in a 63% clinical pregnancy rate. Processing all 639 available 2PN oocytes (standard of care) resulted in a fresh Day3 transfer in all 80 patients and a similar 64% clinical pregnancy rate (ns). However, 399 more oocytes would need to be processed. The strategy of restricting the number of oocytes to be processed would not have compromised cumulative cycle outcome. Considering all subsequent freeze/thawing cycles the cumulative clinical pregnancy rate calculated per all 80 patients would increase to 90%.
Limitations, reasons for caution
The limitation of this approach is that the Aurora Test requires individual oocyte denudation and individual oocyte vitrification. Secondly, this new strategy should be validated in a prospective study.
Wider implications of the findings
By applying this oocyte selection strategy patients would benefit from a high pregnancy rate in the fresh transfer cycle, while the lab would see reduction in embryo culture work, because freeze/thawing cycles and culture of embryos with lower competence would be prevented.
Trial registration number
NA
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Affiliation(s)
| | | | - M Reis
- Fertiga, Fertiga , Jette- Brussels, Belgium
| | | | - G Verheyen
- UZBrussel, Brussels IVF , Brussels, Belgium
| | | | - M Camus
- UZBrussel, Brussels IVF , Brussels, Belgium
| | - P Platteau
- UZBrussel, Brussels IVF , Brussels, Belgium
| | - M De Vos
- UZBrussel, Brussels IVF , Brussels, Belgium
| | - W Coucke
- Sciensano, Quality of Laboratories- , Brussels, Belgium
| | - E Vanhecke
- Fertiga, Fertiga , Jette- Brussels, Belgium
| | | | - J Smitz
- Fertiga, Fertiga , Jette- Brussels, Belgium
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Joffe E, Nowakowski G, Tun H, Rosenthal A, Lunning M, Ramchandren R, Li CC, Zhou L, Martinez E, von Roemeling R, Earhart R, McMahon M, Isufi I, Leslie L. P1121: TAKEAIM LYMPHOMA- AN OPEN-LABEL, DOSE ESCALATION AND EXPANSION TRIAL OF EMAVUSERTIB (CA-4948) IN COMBINATION WITH IBRUTINIB IN PATIENTS WITH RELAPSED OR REFRACTORY HEMATOLOGIC MALIGNANCIES. Hemasphere 2022. [PMCID: PMC9430533 DOI: 10.1097/01.hs9.0000847352.16311.ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Qafiti FN, Marsh AM, Yi S, Rosenthal A, Parreco J, Lopez-Viego MA, Buicko JL. Nationwide Analysis of Hospital admissions Prior to Hartmann's Procedure for Acute Diverticulitis. Am Surg 2022; 88:2148-2157. [PMID: 35483378 DOI: 10.1177/00031348221087378] [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: 11/16/2022]
Abstract
INTRODUCTION Diverticular disease is one of the most common gastrointestinal diseases that require hospital admission. This study aims to identify trends in prior hospital admissions for patients that ultimately require a Hartmann's procedure for complicated diverticulitis. METHODS The Nationwide Readmissions Database for 2010-2014 was queried for all patients aged 18 years or older admitted with an ICD-9 code for colonic diverticulitis and end colostomy creation. Patients with prior hospital admissions were identified. The primary outcome was mortality after Hartmann's procedure. Secondary outcomes were prior hospital admission and previous percutaneous drain placement. Multivariable logistic regression was performed to control for confounding factors for each outcome and results were weighted for national estimates. RESULTS There were 90,162 patients admitted with complicated diverticulitis requiring end colostomy creation. Prior hospital admissions were found in 28.1% (n = 25,307) and 14.4% (n = 12,947) had a previous percutaneous drain placed during a prior admission. The overall mortality rate was 5.9% (n = 5314) after Hartman's procedure. The mortality rate for patients with prior hospital admissions was 8.7% (P < .001), and the mortality rate for patients with previous percutaneous drain placement was 4.3% (P < .001). After controlling for confounding factors including comorbidities, patients with prior admission had an increased risk of mortality (OR 1.48 [1.40-1.58], P < .001) and patients with previous percutaneous drain placement had a decreased risk of mortality (OR .66 [.60-.72], P < .001). CONCLUSIONS Hospitalizations for complications of diverticulitis are a costly burden to our healthcare system. By identifying those patients at high risk for readmission and emergency surgery, perioperative outcomes may be improved.
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Affiliation(s)
- Fred N Qafiti
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Amanda M Marsh
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Slee Yi
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | | | - Miguel A Lopez-Viego
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Jessica L Buicko
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Taaffe J, Croda J, Moultrie H, Silva DS, Rosenthal A, Farhat M. Advancing TB research using digitized programmatic data. Int J Tuberc Lung Dis 2021; 25:890-895. [PMID: 34686230 PMCID: PMC8544923 DOI: 10.5588/ijtld.21.0325] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The use of real-world data from national TB care programs has great potential to answer key research questions in TB control and is now opportune due to increasing digital data collection and storage. We summarize an expert stakeholder workshop conducted on this topic in October 2019, with perspectives from academics, national TB program officers, and data managers. We discuss challenges and opportunities in the use of TB programmatic data for research and describe digital data availability in two large, high TB burden countries, Brazil and South Africa. From this, we posit that with a standardized data collection set, improved data management, and greater collaboration, more TB programmatic data can be used for research with measurable public health impact.
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Affiliation(s)
- J Taaffe
- Office of Cyber Infrastructure and Computational Biology, Department of Health and Human Services, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - J Croda
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil, Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, NJ, USA, Oswaldo Cruz Foundation, Campo Grande, MS, Brazil
| | - H Moultrie
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - D S Silva
- Sydney Health Ethics, University of Sydney School of Public Health, Sydney, NSW, Australia
| | - A Rosenthal
- Office of Cyber Infrastructure and Computational Biology, Department of Health and Human Services, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - M Farhat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
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Saifi O, Breen W, Lester S, Rule W, Stish B, Rosenthal A, Munoz J, Murthy H, Lin Y, Kharfan-Dabaja M, Hoppe B, Peterson J. Radiation Therapy as Bridging Treatment to CAR T Cell Therapy in Non-Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Joffe E, Ramchandren R, Nowakowski G, Rosenthal A, Tun HW, Lunning M, Mead MD, Martinez E, von Roemeling R, Leslie L. AN OPEN‐LABEL TRIAL OF ORAL CA‐4948 AN IRAK4 INHIBITOR COMBINED WITH IBRUTINIB IN ADULT PATIENTS WITH RELAPSED OR REFRACTORY HEMATOLOGIC MALIGNANCIES. Hematol Oncol 2021. [DOI: 10.1002/hon.169_2880] [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: 11/10/2022]
Affiliation(s)
- E. Joffe
- Memorial Sloan Kettering Cancer Center Hematology Oncology‐ Lymphoma Services NY New York USA
| | - R. Ramchandren
- University of Tennessee Medical Center‐ University Cancer Specialists Hematology Medical Oncology Knoxville Tennessee USA
| | - G. Nowakowski
- Mayo Clinic‐Minnesota Rochester MN, Hematology ‐ Cancer Center Rochester Minnesota USA
| | - A. Rosenthal
- Mayo Clinic‐Arizona, Hematology Phoenix Arizona USA
| | - H. W. Tun
- Mayo Clinic Florida Hematology Oncology‐ Caner Center Jacksonville Florida USA
| | - M. Lunning
- University of Nebraska Division of Oncology & Hematology Omaha Nebraska USA
| | - M. D. Mead
- University of California Los Angeles‐ Santa Monica Medical Center Medicine, Hematology and Oncology Santa Monica California USA
| | - E. Martinez
- Curis, Clinical Development Lexington Massachusetts USA
| | | | - L. Leslie
- John Theurer Cancer Center Hackensack, NJ, Hematology Oncology Hackensack New Jersey USA
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Tedeschi S, Pascart T, Latourte A, Godsave C, Kundaki B, Naden R, Taylor W, Dalbeth N, Neogi T, Perez-Ruiz F, Rosenthal A, Becce F, Pascual E, Andrés M, Bardin T, Doherty M, Ea HK, Filippou G, Fitzgerald J, Gutierrez M, Iagnocco A, Jansen T, Kohler M, Lioté F, Matza M, Mccarthy G, Ramonda R, Reginato A, Richette P, Singh J, Sivera F, So A, Stamp L, Yinh J, Yokose C, Terkeltaub R, Choi H, Abhishek A. POS1124 IDENTIFYING POTENTIAL CLASSIFICATION CRITERIA FOR CALCIUM PYROPHOSPHATE DEPOSITION DISEASE (CPPD): RESULTS FROM THE INITIAL PHASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.469] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Classification criteria for calcium pyrophosphate deposition disease (CPPD) will facilitate clinical research on this common crystalline arthritis. ACR/EULAR are jointly sponsoring development of CPPD classification criteria using a multi-phase process.Objectives:To report preliminary results from the first two phases of a four-phase process for developing CPPD classification criteria.Methods:CPPD classification criteria development is overseen by a 12-member Steering Committee. Item generation (Phase I) included a scoping literature review of five literature databases and contributions from a 35-member Combined Expert Committee and two Patient Research Partners. Item reduction and refinement (Phase II) involved a Combined Expert Committee meeting, discussions among Clinical, Imaging, and Laboratory Advisory Groups, and an item rating exercise to assess the influence of individual items toward classification. The Steering Committee reviewed the modal rating score for each item (range -3 [strongly pushes away from CPPD] to +3 [strongly pushes toward CPPD]) to determine items to retain for future phases of criteria development.Results:Item generation yielded 420 items (312 from the literature, 108 from experts/patients). The Advisory Groups eliminated items they agreed were unlikely to distinguish between CPPD and other forms of arthritis, yielding 127 items for the item rating exercise. Fifty-six items, most of which had a modal rating of +/- 2 or 3, were retained for future phases (see Table 1). As numerous imaging items were rated +3, the Steering Committee recommended focusing on imaging of the knee, wrist, and one additional affected joint for calcification suggestive of CPP crystal deposition.Conclusion:The ACR/EULAR CPPD classification criteria working group has adopted both data- and expert-driven approaches, leading to 56 candidate items broadly categorized as clinical, imaging, and laboratory features. Remaining steps for criteria development include domain establishment, item weighting through a multi-criteria decision analysis exercise, threshold score determination, and criteria validation.Table 1.Categories of items retained for future phases of classification criteria developmentAge in decade at symptom onsetAcute inflammatory arthritis (e.g. knee, wrist, 1st MTP joint*)Recurrence and pattern of joint involvement (e.g. 1 self-limited episode, >1 self-limited episode)Physical findings (e.g. palpable subcutaneous tophus*, psoriasis*)Co-morbidities and family history (e.g. Gitelman disease, hemochromatosis, familial CPPD)Osteoarthritis location and features (e.g. 2nd or 3rd MCP joint, wrist)Synovial fluid findings (e.g. CPP crystals present, CPP crystals absent on 1 occasion* or 2 occasions*, monosodium urate crystals present*)Laboratory findings (e.g. hypomagnesemia, hyperparathyroidism, rheumatoid factor*, anti-CCP*)Plain radiograph: calcification in regions of fibro- or hyaline cartilage+Plain radiograph: calcification of the synovial membrane/capsule/tendon+Conventional CT: calcification in regions of fibro- or hyaline cartilage+Conventional CT: calcification of the synovial membrane/capsule/tendon+Ultrasound: CPP crystal deposition in fibro- or hyaline cartilage+Ultrasound: CPP crystal deposition in synovial membrane/capsule/tendons+Dual-energy CT: CPP crystal deposition in fibro- or hyaline cartilage+Dual-energy CT: CPP crystal deposition in synovial membrane/capsule/tendon+*Potential negative predictor +Assessed in the knee, wrist, and/or 1 additional affected jointDisclosure of Interests:Sara Tedeschi Consultant of: NGM Biopharmaceuticals, Tristan Pascart: None declared, Augustin Latourte Consultant of: Novartis, Cattleya Godsave: None declared, Burak Kundaki: None declared, Raymond Naden: None declared, William Taylor: None declared, Nicola Dalbeth Speakers bureau: Abbvie and Janssen, Consultant of: AstraZeneca, Dyve, Selecta, Horizon, Arthrosi, and Cello Health, Tuhina Neogi: None declared, Fernando Perez-Ruiz: None declared, Ann Rosenthal: None declared, Fabio Becce Consultant of: Horizon Therapeutics, Grant/research support from: Siemens Healthineers, Eliseo Pascual: None declared, Mariano Andrés: None declared, Thomas Bardin: None declared, Michael Doherty: None declared, Hang Korng Ea: None declared, Georgios Filippou: None declared, John FitzGerald: None declared, Marwin Gutierrez: None declared, Annamaria Iagnocco: None declared, Tim Jansen Speakers bureau: Abbvie, Amgen, BMS, Grunenthal, Olatec, Sanofi Genzyme, Consultant of: Abbvie, Amgen, BMS, Grunenthal, Olatec, Sanofi Genzyme, Minna Kohler Speakers bureau: Lilly, Consultant of: Novartis, Frederic Lioté: None declared, Mark Matza: None declared, Geraldine McCarthy Consultant of: PK Med, Roberta Ramonda: None declared, Anthony Reginato: None declared, Pascal Richette: None declared, Jasvinder Singh Speakers bureau: Simply Speaking, Consultant of: Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, Francisca Sivera: None declared, Alexander So: None declared, Lisa Stamp: None declared, Janeth Yinh: None declared, Chio Yokose: None declared, Robert Terkeltaub Consultant of: Sobi, Horizon Therapeutics, Astra-Zeneca, Selecta, Grant/research support from: Astra-Zeneca, Hyon Choi: None declared, Abhishek Abhishek Consultant of: NGM Biopharmaceuticals.
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Rajan M, Middleton R, Field A, Pineda C, Kiffin N, Rosenthal A. Effectiveness of surgical residents compared to surgical faculty in teaching trauma evaluation and management. Trauma 2021. [DOI: 10.1177/14604086211012245] [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: 11/15/2022]
Abstract
Introduction Senior medical students learn trauma principles in a 90-min interactive teaching session based on the trauma evaluation and management module designed by the American College of Surgeons. However, the number of surgical faculty available to conduct these interactive small group sessions is limited. The goal of this study is to compare the effectiveness of surgical residents to that of surgical faculty in teaching trauma principles. Methods 53 senior medical students received trauma teaching from trauma faculty ( n = 22), trauma residents ( n = 21), or no teaching ( n = 10). Students were tested on cognitive trauma knowledge (20 multiple choice questions) and clinical trauma simulation (using objective structured clinical performance score). All students completed a 5-point subjective questionnaire. Results Students receiving trauma teaching outperformed students receiving no teaching in the knowledge test (mean 13.0 ± 3.6 standard deviation (SD) vs. 8.4 ± 2.4 SD, p < 0.05), while faculty and resident teaching outcomes were similar (mean 12.6 ± 3.0 SD vs. 13.4 ± 4.1, p = 0.45). Similarly, in the clinical trauma simulation, students receiving trauma teaching scored better (objective score mean 78% vs. 56%, p < 0.05), while there was no difference between faculty and resident teaching outcomes (objective score mean 77% vs. 80%, p = 0.52). In the subjective questionnaire, students who received trauma teaching rated themselves higher on a scale of 10 in trauma knowledge and skills than those who did not have formal teaching (mean 5.2 vs. 2.1, p < 0.05) as resident and attending teaching group ratings were similar. Conclusions Although small group discussions and increased simulation enhance undergraduate surgical trauma education, the number of faculty surgeons needed to fully incorporate these activities is limited. Objective and perceived effectiveness of teaching trauma management by surgical residents compared to trauma attendings is equivalent. This highlights the opportunity to incorporate residents into teaching roles to bridge the gap in undergraduate trauma education.
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Affiliation(s)
| | - Ravyn Middleton
- University of Texas Health Sciences Center at San Antonio, TX, USA
| | - Alyssa Field
- University of Texas Health Sciences Center at San Antonio, TX, USA
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Hranjec T, Estreicher M, Rogers B, Kohler L, Solomon R, Hennessy S, Cibulas M, Hurst D, Hegazy M, Lee J, Perez D, Doctor N, Kiffin C, Pigneri D, LaGuardia H, Shaw K, Arenas J, Rosenthal A, Katz RS, Sawyer RG, Pepe PE. Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019-Related Coagulopathy. Crit Care Explor 2020; 2:e0287. [PMID: 33381763 PMCID: PMC7769351 DOI: 10.1097/cce.0000000000000287] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Coagulopathy of coronavirus disease 2019 is largely described as hypercoagulability, yet both thrombotic and hemorrhagic complications occur. Although therapeutic and prophylactic anticoagulant interventions have been recommended, empiric use of antifactor medications (heparin/enoxaparin) may result in hemorrhagic complications, including death. Furthermore, traditional (antifactor) anticoagulation does not address the impact of overactive platelets in coronavirus disease 2019. The primary aim was to evaluate if algorithm-guided thromboelastography with platelet mapping could better characterize an individual's coronavirus disease 2019-relatedcoagulopathic state and, secondarily, improve outcomes. DESIGN SETTING AND PATIENTS Coronavirus disease 2019 patients (n = 100), receiving thromboelastography with platelet mapping assay upon admission to an 800-bed tertiary-care hospital, were followed prospectively by a hospital-based thromboelastography team. Treating clinicians were provided with the option of using a pre-established algorithm for anticoagulation, including follow-up thromboelastography with platelet mapping assays. Two groups evolved: 1) patients managed by thromboelastography with platelet mapping algorithm (algorithm-guided-thromboelastography); 2) those treated without thromboelastography with platelet mapping protocols (non-algorithm-guided). Outcomes included thrombotic/hemorrhagic complications, pulmonary failure, need for mechanical ventilation, acute kidney injury, dialysis requirement, and nonsurvival. INTERVENTIONS Standard-of-care therapy with or without algorithm-guided-thromboelastography support. MEASUREMENTS AND MAIN RESULTS Although d-dimer, C-reactive protein, and ferritin were elevated significantly in critically ill (nonsurvivors, acute kidney injury, pulmonary failure), they did not distinguish between coagulopathic and noncoagulopathic patients. Platelet hyperactivity (maximum amplitude-arachidonic acid/adenosine diphosphate > 50 min), with or without thrombocytosis, was associated with thrombotic/ischemic complications, whereas severe thrombocytopenia (platelet count < 100,000/μL) was uniformly fatal. Hemorrhagic complications were observed with decreased factor activity (reaction time > 8 min). Non-algorithm-guided patients had increased risk for subsequent mechanical ventilation (relative risk = 10.9; p < 0.0001), acute kidney injury (relative risk = 2.3; p = 0.0017), dialysis (relative risk = 7.8; p < 0.0001), and death (relative risk = 7.7; p < 0.0001), with 17 of 28 non-algorithm-guided patients (60.7%) dying versus four algorithm-guided-thromboelastography patients (5.6%) (p < 0.0001). Thromboelastography with platelet mapping-guided antiplatelet treatment decreased mortality 82% (p = 0.0002), whereas non-algorithm-guided (compared with algorithm-guided-thromboelastography) use of antifactor therapy (heparin/enoxaparin) resulted in 10.3-fold increased mortality risk (p = 0.0001). CONCLUSIONS Thromboelastography with platelet mapping better characterizes the spectrum of coronavirus disease 2019 coagulation-related abnormalities and may guide more tailored, patient-specific therapies in those infected with coronavirus disease 2019.
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Affiliation(s)
- Tjasa Hranjec
- Division of Transplantation, Memorial Regional Hospital, Hollywood, FL
- Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL
| | | | | | - Lisa Kohler
- Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL
| | - Rachele Solomon
- Division of Transplantation, Memorial Regional Hospital, Hollywood, FL
| | - Sara Hennessy
- Department of Surgery, Division of Trauma/Acute Care/Critical Care Surgery, Bariatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Deborah Hurst
- Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL
| | - Mohamed Hegazy
- Division of Transplantation, Memorial Regional Hospital, Hollywood, FL
| | - Jieun Lee
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | - Donny Perez
- Emergency Department, Memorial Regional Hospital, Hollywood, FL
| | | | - Chauniqua Kiffin
- Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL
| | - Danielle Pigneri
- Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL
| | - Heather LaGuardia
- Division of Transplantation, Memorial Regional Hospital, Hollywood, FL
| | - Kathryn Shaw
- Division of Transplantation, Memorial Regional Hospital, Hollywood, FL
| | - Juan Arenas
- Division of Transplantation, Memorial Regional Hospital, Hollywood, FL
| | - Andrew Rosenthal
- Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL
| | - Randy S Katz
- Emergency Department, Memorial Regional Hospital, Hollywood, FL
| | - Robert G Sawyer
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Paul E Pepe
- Metropolitan Emergency Medical Services Medical Directors Alliance, Dallas, TX
- Department of Management, Policy and Community Health, University of Texas Health Sciences Center, School of Public Health, Houston, TX
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22
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Schraa O, Rosenthal A, Wade MJ, Rieger L, Miletić I, Alex J. Assessment of aeration control strategies for biofilm-based partial nitritation/anammox systems. Water Sci Technol 2020; 81:1757-1765. [PMID: 32644968 DOI: 10.2166/wst.2020.174] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The objective of this work was to compare the nitrogen removal in mainstream, biofilm-based partial nitritation anammox (PN/A) systems employing (1) constant setpoint dissolved oxygen (DO) control, (2) intermittent aeration, and (3) ammonia-based aeration control (ABAC). A detailed water resource recovery facility (WRRF) model was used to study the dynamic performance of these aeration control strategies with respect to treatment performance and energy consumption. The results show that constant setpoint DO control cannot meet typical regulatory limits for total ammonia nitrogen (NHx-N). Intermittent aeration shows improvement but requires optimisation of the aeration cycle. ABAC shows the best treatment performance with the advantages of continuous operation and over 20% lower average energy consumption as compared to intermittent aeration.
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Affiliation(s)
- O Schraa
- inCTRL Solutions Inc., Dundas, ON, Canada E-mail:
| | | | - M J Wade
- School of Engineering, Newcastle University, Newcastle-upon-Tyne, UK and Dept. of Mathematics and Statistics, McMaster University, Hamilton, ON, Canada
| | - L Rieger
- inCTRL Solutions Inc., Dundas, ON, Canada E-mail:
| | - I Miletić
- inCTRL Solutions Inc., Dundas, ON, Canada E-mail:
| | - J Alex
- ifak e.V., Magdeburg, Germany
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23
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Silverstein JW, Rosenthal A, Kwan K, Wagner K, Ellis JA. Application of Multimodal Neuromonitoring in Posterior Inferior Cerebellar Artery Aneurysm Clippings: Review of Two Cases. Cureus 2020; 12:e7296. [PMID: 32313737 PMCID: PMC7163345 DOI: 10.7759/cureus.7296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neurophysiological monitoring is advocated for the prevention of neurological sequelae secondary to the clipping of an aneurysm involved in posterior circulation. Unfortunately, there is a paucity in the literature regarding what neurophysiological monitoring techniques are best employed. The authors here present two cases where multimodal neuromonitoring techniques were used during the clippings of two posterior inferior cerebellar artery (PICA) aneurysms. There is increased neurologic morbidity associated with PICA aneurysm clippings, as a number of eloquent structures live in close proximity to the PICA. The application of a multimodal neuromonitoring paradigm may reduce a poor neurological outcome.
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24
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Silverstein JW, Rosenthal A, Patel NV, Boockvar JA. Electrophysiological Mapping and Monitoring during an Awake Craniotomy for Low-Grade Glioma: Case Report. Neurodiagn J 2019; 59:133-141. [PMID: 31233378 DOI: 10.1080/21646821.2019.1627148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/03/2023]
Abstract
Awake craniotomy is advocated for the resection of supratentorial low-grade gliomas (LGG). The combination of neurophysiological electrical mapping techniques and performing the craniotomy awake has demonstrated increased total and supratotal resection of LGG, as well as increased overall survival rates. We present an illustrative case where the patient's gross motor function deteriorated during the resection of a LGG and mapping techniques using the phase reversal technique and Taniguchi direct cortical stimulation technique while the patient was awake proved to be valuable in determining continuity of the corticospinal tracts.
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Affiliation(s)
- Justin W Silverstein
- Neuro Protective Solutions , New York , New York.,Department of Neurology Lenox Hill Hospital Northwell Health , New York , New York
| | | | - Nitesh V Patel
- Department of Neurosurgery Lenox Hill Hospital Northwell Health , New York , New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell , New York , New York
| | - John A Boockvar
- Department of Neurosurgery Lenox Hill Hospital Northwell Health , New York , New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell , New York , New York
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25
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Wolf B, Fisk I, Rosenthal A, Chen J. The fifth international conference on Food Oral Processing, University of Nottingham, July 2018. J Texture Stud 2019; 50:193. [PMID: 31111959 DOI: 10.1111/jtxs.12446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bettina Wolf
- University of Birmingham, Birmingham B15 2TT, UK
| | - Ian Fisk
- University of Nottingham, Nottingham, UK
| | | | - Jianshe Chen
- Zhejiang Gongshang University, Hangzhou, Zhejiang, China
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26
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Tinguely R, Rosenthal A, Simpson R, Ballinger S, Creely A, Frank S, Kuang A, Linehan B, McCarthy W, Milanese L, Montes K, Mouratidis T, Picard J, Rodriguez-Fernandez P, Sandberg A, Sciortino F, Tolman E, Zhou M, Sorbom B, Hartwig Z, White A. Neutron diagnostics for the physics of a high-field, compact, Q ≥ 1 tokamak. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.03.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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27
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Nishinari K, Fang Y, Rosenthal A. Human oral processing and texture profile analysis parameters: Bridging the gap between the sensory evaluation and the instrumental measurements. J Texture Stud 2019; 50:369-380. [DOI: 10.1111/jtxs.12404] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/15/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Katsuyoshi Nishinari
- Glyn O. Phillips Hydrocolloids Research CentreSchool of Food and Biological Engineering, Hubei University of Technology Wuhan Hubei China
| | - Yapeng Fang
- Department of Food Science and EngineeringSchool of Agriculture and Biology, Shanghai Jiao Tong University Minhang Shanghai China
| | - Andrew Rosenthal
- Division of Food, Nutrition and DieteticsSchool of Biosciences, University of Nottingham Sutton Bonington UK
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28
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Rosenthal A, Stoddard M, Chipps L, Herrmann J. Skin cancer prevention: a review of current topical options complementary to sunscreens. J Eur Acad Dermatol Venereol 2019; 33:1261-1267. [PMID: 30801825 DOI: 10.1111/jdv.15522] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/29/2019] [Indexed: 02/04/2023]
Abstract
The incidence of non-melanoma skin cancer (NMSC) is dramatically increasing worldwide, despite the increased use of improved sunscreens. In 2014, the Surgeon General estimated that 2.2-5.0 million people were treated annually for NMSC. As the number of newly diagnosed skin cancers continues to rise, there is a need for additional preventative measures beyond sunscreens. Several newer topical products that focus on boosting DNA repair, modulating DNA transcription, decreasing inflammation and selectively targeting precancerous cells may play an important role in future skin cancer prevention.
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Affiliation(s)
- A Rosenthal
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology, Beverly Hills, CA, USA
| | - M Stoddard
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology, Beverly Hills, CA, USA
| | - L Chipps
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology, Beverly Hills, CA, USA.,Department of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - J Herrmann
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology, Beverly Hills, CA, USA.,Department of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA
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29
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Eyerly-Webb S, Solomon R, Young L, Bard K, Laituri C, Rosenthal A, Long J. Impact of Holidays on Pediatric Trauma Admissions to a Community Hospital in South Florida. South Med J 2019; 112:164-169. [PMID: 30830230 DOI: 10.14423/smj.0000000000000947] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The data from temperate regions indicate increases in pediatric traumatic injuries during the spring and summer months with anticipated admission spikes on warm weather holidays; hospitals in southern subtropical regions should not anticipate the same trends. The objectives of this study were to identify holiday-specific spikes in pediatric traumatic injury admissions at a community hospital in South Florida and report injury patterns in age, mechanism of injury, and surgical consults. METHODS A 5-year retrospective review of pediatric traumatic injuries during holiday periods was conducted; patterns in age, mechanism of injury, and surgical consults were described. A ratio of the mean number of patients seen per day for holiday periods versus nonholiday days of the same month was calculated for each holiday. RESULTS The most notable spikes in injury volume were for autumn and winter holidays; average volume doubled during the holiday periods for New Year's Day, Super Bowl weekend, Valentine's Day, St Patrick's Day, and Halloween. Holiday periods had increases in the proportion of injuries related to motorcycle crashes. CONCLUSIONS Hospitals located in southern subtropical climates should consider increasing staffing as necessary during select autumn and winter holidays.
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Affiliation(s)
- Stephanie Eyerly-Webb
- From the Departments of Pediatric Trauma Services, Division of Acute Care Surgery and Trauma, and the Office of Human Research, Memorial Regional and Joe DiMaggio Children's Hospitals, Hollywood, Florida
| | - Rachele Solomon
- From the Departments of Pediatric Trauma Services, Division of Acute Care Surgery and Trauma, and the Office of Human Research, Memorial Regional and Joe DiMaggio Children's Hospitals, Hollywood, Florida
| | - LeAnne Young
- From the Departments of Pediatric Trauma Services, Division of Acute Care Surgery and Trauma, and the Office of Human Research, Memorial Regional and Joe DiMaggio Children's Hospitals, Hollywood, Florida
| | - Keren Bard
- From the Departments of Pediatric Trauma Services, Division of Acute Care Surgery and Trauma, and the Office of Human Research, Memorial Regional and Joe DiMaggio Children's Hospitals, Hollywood, Florida
| | - Carrie Laituri
- From the Departments of Pediatric Trauma Services, Division of Acute Care Surgery and Trauma, and the Office of Human Research, Memorial Regional and Joe DiMaggio Children's Hospitals, Hollywood, Florida
| | - Andrew Rosenthal
- From the Departments of Pediatric Trauma Services, Division of Acute Care Surgery and Trauma, and the Office of Human Research, Memorial Regional and Joe DiMaggio Children's Hospitals, Hollywood, Florida
| | - Julie Long
- From the Departments of Pediatric Trauma Services, Division of Acute Care Surgery and Trauma, and the Office of Human Research, Memorial Regional and Joe DiMaggio Children's Hospitals, Hollywood, Florida
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30
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Silverstein JW, Rosenthal A, Ellis JA. Direct Cortical Motor Evoked Potentials Versus Transcranial Motor Evoked Potentials for the Detection of Cortical Ischemia During Supratentorial Craniotomy: Case Report. Cureus 2018; 10:e3771. [PMID: 30820390 PMCID: PMC6389021 DOI: 10.7759/cureus.3771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transcranial motor evoked potential (TCMEP) and direct cortical motor evoked potential (DCMEP) paradigms have historically been used contemporaneously or independently for supratentorial craniotomies. DCMEP provides focal stimulation to the cortical surface, whereas TCMEP stimulation is more variable and may be activating structures deeper than those at risk during a supratentorial craniotomy. We present the case report for a 65-year-old female who underwent a supratentorial craniotomy for the clipping of a right-sided unruptured middle cerebral artery (MCA) aneurysm. DCMEP recordings of the upper extremity degraded after the parent vessel was temporarily occluded with a clip. The recordings returned once the clip was released. The DCMEP lower extremity recordings did not deviate from their established baseline. TCMEP recordings (upper and lower extremities) also did not deviate from their established baselines. The permanent clip was placed without incident, and the patient awoke neurologically intact. This case study demonstrates the specificity and sensitivity of DCMEP vs. TCMEP. DCMEP activates the corticospinal tract more superficially; therefore, it was evident by the loss of the upper extremity DCMEPs without the loss of lower extremity DCMEPs that the temporary vessel occlusion caused an ischemic event focal to the cortical area perfused by the MCA. This ischemic event was not detected by TCMEP.
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31
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Korducki J, Tidemann A, Tarima S, Grindel S, Urbain J, Mickschl D, Rosenthal A, Burns E. NATURAL INTERFACES FOR EVALUATION AND MANAGEMENT OF SHOULDER DYSFUNCTION. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - J Urbain
- Milwaukee School of Engineering University
| | | | | | - E Burns
- Medical College Of Wisconsin
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32
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Eyerly-Webb SA, Solomon R, Lee SK, Sanchez R, Carrillo EH, Davare DL, Kiffin C, Rosenthal A. Lightning Burns and Electrical Trauma in a Couple Simultaneously Struck by Lightning. Clin Pract Cases Emerg Med 2018; 1:246-250. [PMID: 29849308 PMCID: PMC5965181 DOI: 10.5811/cpcem.2017.4.33706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/11/2022] Open
Abstract
More people are struck and killed by lightning each year in Florida than any other state in the United States. This report discusses a couple that was simultaneously struck by lightning while walking arm-in-arm. Both patients presented with characteristic lightning burns and were admitted for hemodynamic monitoring, serum labs, and observation and were subsequently discharged home. Despite the superficial appearance of lightning burns, serious internal electrical injuries are common. Therefore, lightning strike victims should be admitted and evaluated for cardiac arrhythmias, renal injury, and neurological sequelae.
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Affiliation(s)
| | - Rachele Solomon
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Seong K Lee
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Rafael Sanchez
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Eddy H Carrillo
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Dafney L Davare
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Chauniqua Kiffin
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Andrew Rosenthal
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
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33
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Jiang J, Adams H, Lange M, Siemann S, Feldkamp M, Schulze S, Froehler S, Yaung S, Yao L, Balasubramanyam A, Tikoo N, Achenbach H, Krügel R, Palma J, Rosenthal A. OA 10.06 Longitudinal Mutation Monitoring in Plasma by Deep Sequencing as a Potential Predictor of Disease Progression in NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.386] [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: 10/18/2022]
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34
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Rosenthal A, Lange M, Beckert S, Hinzmann B, Woestmann C, Wehnl B, Schneider M, Meister M, Thomas M, Muley T, Warth A, Froehler S, Palma J, Herth F. P1.15-011 Longitudinal Mutation Monitoring in Plasma Without Matching Tumor Tissue by Deep Sequencing in Small Cell Lung Cancer (SCLC). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1047] [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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35
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Gabriel JG, Contreras A, Rosenthal A. Use of a Technetium99m-Sestamibi Scan to Detect Ipsilateral Double Adenoma in a Patient with Primary Hyperparathyroidism: A Case Report. Perm J 2017; 21:16-185. [PMID: 28746021 DOI: 10.7812/tpp/16-185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with primary hyperparathyroidism generally have a single parathyroid adenoma that causes excessive excretion of parathyroid hormone. For about 2% to 15% of these patients, a double adenoma is present that involves one lesion on each side of the neck. CASE PRESENTATION We describe a case of double parathyroid adenoma causing asymptomatic hypercalcemia. A presurgical technetium99m (Tc99m) sestamibi scan suggested an ipsilateral double adenoma in the left thyroid lobe. An intraoperative parathyroid hormone assay confirmed its successful removal. DISCUSSION Although double adenomas are not yet widely acknowledged, presurgical imaging and nuclear scans can help to localize multiple lesions, and intraoperative parathyroid hormone assays can confirm the diagnosis and cure.
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Affiliation(s)
- Joseph Gabriel Gabriel
- Resident in Internal Medicine at the East Tennessee State University James H Quillen College of Medicine in Johnson City.
| | | | - Andrew Rosenthal
- Associate Director of Trauma Services at Memorial Regional Hospital in Hollywood, FL.
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36
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Wells GF, Shi Y, Laureni M, Rosenthal A, Szivák I, Weissbrodt DG, Joss A, Buergmann H, Johnson DR, Morgenroth E. Comparing the Resistance, Resilience, and Stability of Replicate Moving Bed Biofilm and Suspended Growth Combined Nitritation-Anammox Reactors. Environ Sci Technol 2017; 51:5108-5117. [PMID: 28374996 DOI: 10.1021/acs.est.6b05878] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Combined partial nitritation-anammox (PN/A) systems are increasingly being employed for sustainable removal of nitrogen from wastewater, but process instabilities present ongoing challenges for practitioners. The goal of this study was to elucidate differences in process stability between PN/A process variations employing two distinct aggregate types: biofilm [in moving bed biofilm reactors (MBBRs)] and suspended growth biomass. Triplicate reactors for each process variation were studied under baseline conditions and in response to a series of transient perturbations. MBBRs displayed elevated NH4+ removal rates relative to those of suspended growth counterparts over six months of unperturbed baseline operation but also exhibited significantly greater variability in performance. Transient perturbations led to strikingly divergent yet reproducible behavior in biofilm versus suspended growth systems. A temperature perturbation prompted a sharp reduction in NH4+ removal rates with no accumulation of NO2- and rapid recovery in MBBRs, compared to a similar reduction in NH4+ removal rates but a high level of accumulation of NO2- in suspended growth reactors. Pulse additions of a nitrification inhibitor (allylthiourea) prompted only moderate declines in performance in suspended growth reactors compared to sharp decreases in NH4+ removal rates in MBBRs. Quantitative fluorescence in situ hybridization demonstrated a significant enrichment of anammox in MBBRs compared to suspended growth reactors, and conversely a proportionally higher AOB abundance in suspended growth reactors. Overall, MBBRs displayed significantly increased susceptibility to transient perturbations employed in this study compared to that of suspended growth counterparts (stability parameter), including significantly longer recovery times (resilience). No significant difference in the maximal impact of perturbations (resistance) was apparent. Taken together, our results suggest that aggregate architecture (biofilm vs suspended growth) in PN/A processes exerts an unexpectedly strong influence on process stability.
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Affiliation(s)
- G F Wells
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , 8600 Dübendorf, Switzerland
- Department of Civil and Environmental Engineering, Northwestern University , Evanston, Illinois 60208, United States
| | - Y Shi
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , 8600 Dübendorf, Switzerland
- Department of Environmental Science and Engineering, Shandong University , Jinan, China
| | - M Laureni
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , 8600 Dübendorf, Switzerland
- Institute of Environmental Engineering, ETH Zürich , 8093 Zürich, Switzerland
| | - A Rosenthal
- Department of Civil and Environmental Engineering, Northwestern University , Evanston, Illinois 60208, United States
| | - I Szivák
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , 8600 Dübendorf, Switzerland
| | - D G Weissbrodt
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , 8600 Dübendorf, Switzerland
- Institute of Environmental Engineering, ETH Zürich , 8093 Zürich, Switzerland
| | - A Joss
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , 8600 Dübendorf, Switzerland
| | - H Buergmann
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , 8600 Dübendorf, Switzerland
| | - D R Johnson
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , 8600 Dübendorf, Switzerland
- Department of Environmental Systems Science, ETH Zürich , 8093 Zürich, Switzerland
| | - E Morgenroth
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , 8600 Dübendorf, Switzerland
- Institute of Environmental Engineering, ETH Zürich , 8093 Zürich, Switzerland
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Speiser S, Geisler S, Speiser L, Heinze G, Rosenthal A, Speiser P. Short-term Efficacy of trichloroacetic acid in the treatment of cervical intraepithelial neoplasia. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1582214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Wick MJ, Vaught T, Meade J, Gamez L, Farley M, Tolcher AW, Rasco D, Patnaik A, Drengler RL, Rosenthal A, Papadopoulos KP. Abstract P3-03-05: Establishment and evaluation of ER+ breast cancer models using an optimized methodology for exogenous hormone delivery. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-03-05] [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
Preclinical in vivo models of estrogen receptor positive (ER+) breast cancer rely on exogenous supplementation of hormones for growth. This requirement leads to animal toxicity and mortality over time, limiting development and drug testing in these types of models. Efficacy of test agents, particularly endocrine therapies, may also be altered in these models due to excessive hormone exposure, highlighting the need to improve methods for the establishment and testing of ER+ breast models.
We have developed an alternative method of hormone supplementation in ER+ breast cancer models and optimized this method for testing of endocrine therapies. Using two cell-based breast models, we demonstrated improved breast tumor take and time to tumor volume endpoint while reducing animal toxicity and mortality associated with standard hormone supplementation. Subsequent studies identified the lowest effective dose (LED) of supplement for hormone dependent model growth with a preclinically relevant time to tumor volume endpoint. Activity of endocrine therapies including tamoxifen, letrozole, fulvestrant and exemestane were compared at the standard and LED hormone concentrations. In these studies tamoxifen treatment resulted in tumor regressions which was not appreciably improved using the LED dose of supplement. However letrozole activity was improved in the LED study suggesting hormone supplementation can impact activity of some agents. Using this process we also generated a panel of ER+ patient-derived xenograft (PDX) models, including two novel hormone therapy responsive models from chemo-naïve or hormone therapy pretreated patients, designated ST986 and ST2177, respectively.
This improved method of hormone supplementation diminishes the adverse effects of standard hormone supplementation and provides utility for development of anticancer therapies in ER+ breast models.
Citation Format: Wick MJ, Vaught T, Meade J, Gamez L, Farley M, Tolcher AW, Rasco D, Patnaik A, Drengler RL, Rosenthal A, Papadopoulos KP. Establishment and evaluation of ER+ breast cancer models using an optimized methodology for exogenous hormone delivery. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-03-05.
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Affiliation(s)
- MJ Wick
- START, San Antonio, TX; START Center, San Antonio, TX
| | - T Vaught
- START, San Antonio, TX; START Center, San Antonio, TX
| | - J Meade
- START, San Antonio, TX; START Center, San Antonio, TX
| | - L Gamez
- START, San Antonio, TX; START Center, San Antonio, TX
| | - M Farley
- START, San Antonio, TX; START Center, San Antonio, TX
| | - AW Tolcher
- START, San Antonio, TX; START Center, San Antonio, TX
| | - D Rasco
- START, San Antonio, TX; START Center, San Antonio, TX
| | - A Patnaik
- START, San Antonio, TX; START Center, San Antonio, TX
| | - RL Drengler
- START, San Antonio, TX; START Center, San Antonio, TX
| | - A Rosenthal
- START, San Antonio, TX; START Center, San Antonio, TX
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Rosenthal A, Luthi J, Belohlavek M, Kortüm KM, Mookadam F, Mayo A, Fonseca R, Bergsagel PL, Reeder CB, Mikhael JR, Stewart AK. Carfilzomib and the cardiorenal system in myeloma: an endothelial effect? Blood Cancer J 2016; 6:e384. [PMID: 26771810 PMCID: PMC4742629 DOI: 10.1038/bcj.2015.112] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/30/2015] [Accepted: 12/04/2015] [Indexed: 11/09/2022] Open
Abstract
Carfilzomib (Cfz) has been associated with an ~5% incidence of unexplained and unpredictable cardiovascular toxicity in clinical trials. We therefore implemented a detailed, prospective, clinical cardiac and renal evaluation of 62 Cfz-treated myeloma patients, including serial blood pressure (BP), creatinine, troponin, NT-proBNP and pre- and post-treatment echocardiograms, including ejection fraction (EF), average global longitudinal strain and compliance. Pre-treatment elevations in NT-proBNP and BP, as well as abnormal cardiac strain were common. A rise in NT-proBNP occurred frequently post-treatment often without corresponding cardiopulmonary symptoms. A rise in creatinine was common, lessened with hydration and often reversible. All patients had a normal EF pre-treatment. Five patients experienced a significant cardiac event (four decline in EF and one myocardial infarction), of which 2 (3.2%) were considered probably attributable to Cfz. None were rechallenged with Cfz. The ideal strategy for identifying patients at risk for cardiac events, and parameters by which to monitor for early toxicity have not been established; however, it appears baseline echocardiographic testing is not consistently predictive of toxicity. The toxicities observed suggest an endothelial mechanism and further clinical trials are needed to determine whether or not this represents a class effect or is Cfz specific.
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Affiliation(s)
- A Rosenthal
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - J Luthi
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - M Belohlavek
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - K M Kortüm
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - F Mookadam
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - A Mayo
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - R Fonseca
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - P L Bergsagel
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - C B Reeder
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - J R Mikhael
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - A K Stewart
- Division of Hematology Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Lee SK, Carrillo EH, Rosenthal A, Sanchez R, Kiffin C, Davare DL. Acute Care/Trauma Surgeon's role in obstetrical/gynecologic emergencies (The OBCAT Alert). World J Emerg Med 2016; 7:274-277. [PMID: 27942344 DOI: 10.5847/wjem.j.1920-8642.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/19/2022] Open
Abstract
BACKGROUND Overwhelming hemorrhage or other intra-abdominal complications may be associated with obstetrical or gynecologic (OB/GYN) procedures and may require the surgical training of an Acute Care/Trauma Surgeon. The OB Critical Assessment Team (OBCAT Alert) was developed at our institution to facilitate a multidisciplinary response to complex OB/GYN cases. We sought to review and characterize the Acute Care/Trauma Surgeon's role in these cases. METHODS We conducted a retrospective review of all emergency consults during an OB/GYN case at our institution from 2008 to 2015. An OBCAT is a hospital based alert system designed to immediately notify OB/GYN, anesthesiology, Acute Care/Trauma, the intensive care unit (ICU), and the blood bank of a potential emergency during an OB/GYN case. RESULTS There were 7±3 OBCAT alerts/year. Seventeen patients required Acute Care/Trauma surgery intervention for hemorrhage. Thirteen patients required damage control packing during their hospitalization. Blood loss averaged 6.8±5.5 L and patients received a total of 21±14 units during deliveries with hemorrhage. There were 17 other surgical interventions not related to hemorrhage; seven of these cases were related to adhesions or intestinal injury. Seven additional cases required evaluation post routine OB/GYN procedure; the most common reason was for severe wound complications. There were three deaths during this study period. CONCLUSION Emergency OB/GYN cases are associated with high morbidity and may require damage control or other surgical techniques in cases of overwhelming hemorrhage. Acute Care/Trauma Surgeons have a key role in the treatment of these complex cases.
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Affiliation(s)
- Seong K Lee
- Division of Acute Care Surgery and Trauma, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Eddy H Carrillo
- Division of Acute Care Surgery and Trauma, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Andrew Rosenthal
- Division of Acute Care Surgery and Trauma, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Rafael Sanchez
- Division of Acute Care Surgery and Trauma, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Chauniqua Kiffin
- Division of Acute Care Surgery and Trauma, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Dafney L Davare
- Division of Acute Care Surgery and Trauma, Memorial Regional Hospital, Hollywood, FL 33021, USA
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Hawthornthwaite D, Ramjan Y, Rosenthal A. Oral Processing of Low Water Content Foods - A Development to Hutchings and Lillford's Breakdown Path. J Texture Stud 2015. [DOI: 10.1111/jtxs.12126] [Citation(s) in RCA: 6] [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: 11/28/2022]
Affiliation(s)
| | - Yaneez Ramjan
- Department of Applied Sciences and Health; Coventry University; Coventry CV1 5FB UK
| | - Andrew Rosenthal
- Department of Applied Sciences and Health; Coventry University; Coventry CV1 5FB UK
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Song LN, Silva J, Koller A, Rosenthal A, Chen EI, Gelmann EP. The Tumor Suppressor NKX3.1 Is Targeted for Degradation by DYRK1B Kinase. Mol Cancer Res 2015; 13:913-22. [PMID: 25777618 PMCID: PMC4511920 DOI: 10.1158/1541-7786.mcr-14-0680] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/04/2015] [Indexed: 12/27/2022]
Abstract
UNLABELLED NKX3.1 is a prostate-specific homeodomain protein and tumor suppressor whose expression is reduced in the earliest phases of prostatic neoplasia. NKX3.1 expression is not only diminished by genetic loss and methylation, but the protein itself is a target for accelerated degradation caused by inflammation that is common in the aging prostate gland. NKX3.1 degradation is activated by phosphorylation at C-terminal serine residues that mediate ubiquitination and protein turnover. Because NKX3.1 is haploinsufficient, strategies to increase its protein stability could lead to new therapies. Here, a high-throughput screen was developed using an siRNA library for kinases that mediate NKX3.1 degradation. This approach identified several candidates, of which DYRK1B, a kinase that is subject to gene amplification and overexpression in other cancers, had the greatest impact on NKX3.1 half-life. Mechanistically, NKX3.1 and DYRK1B were shown to interact via the DYRK1B kinase domain. In addition, an in vitro kinase assay showed that DYRK1B phosphorylated NKX3.1 at serine 185, a residue critical for NKX3.1 steady-state turnover. Lastly, small-molecule inhibitors of DYRK1B prolonged NKX3.1 half-life. Thus, DYRK1B is a target for enzymatic inhibition in order to increase cellular NKX3.1. IMPLICATIONS DYRK1B is a promising and novel kinase target for prostate cancer treatment mediated by enhancing NKX3.1 levels.
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Affiliation(s)
| | - Jose Silva
- Icahn 9th Floor, Office L9-20F, 1425 Madison Avenue, New York, New York 10029-6574
| | - Antonius Koller
- Proteomics Shared Resource at the Herbert Irving Comprehensive Cancer Center, 177 Ft. Washington Ave., MHB 6N-435, New York, NY, 10032, 212-305-8602, Fax 212-305-3035
| | - Andrew Rosenthal
- NIH Chemical Genomics Center, 9800 Medical Center Drive, MSC 3370, Bethesda, MD 20892-3370
| | - Emily I. Chen
- Proteomics Shared Resource at the Herbert Irving Comprehensive Cancer Center, 177 Ft. Washington Ave., MHB 6N-435, New York, NY, 10032, 212-305-8602, Fax 212-305-3035
- Department of Pharmacology, Columbia University Medical Center, Herbert Irving Comprehensive Cancer Center, Columbia University, 177 Ft. Washington Ave., MHB 6N-435, New York, NY, 10032, 212-305-8602, Fax 212-305-3035
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Castañeda AR, Rosenthal A. Persistent abnormalities after repair of congenital heart defects. Ventricular septal defect and tetralogy of Fallot. Adv Cardiol 2015; 20:110-6. [PMID: 848382 DOI: 10.1159/000399859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Henrique NA, Deliza R, Rosenthal A. Consumer Sensory Characterization of Cooked Ham Using the Check-All-That-Apply (CATA) Methodology. Food Eng Rev 2014. [DOI: 10.1007/s12393-014-9094-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Meads C, Sutton A, Małysiak S, Kowalska M, Zapalska A, Rogozinska E, Baldwin P, Rosenthal A, Ganesan R, Borowiack E, Barton P, Roberts T, Sundar S, Khan K. Sentinel lymph node status in vulval cancer: systematic reviews of test accuracy and decision-analytic model-based economic evaluation. Health Technol Assess 2014; 17:1-216. [PMID: 24331128 DOI: 10.3310/hta17600] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Vulval cancer causes 3-5% of all gynaecological malignancies and requires surgical removal and inguinofemoral lymphadenectomy (IFL). Complications affect > 50% of patients, including groin wound infection, lymphoedema and cellulitis. A sentinel lymph node (SLN) is the first groin node with the highest probability of malignancy. SLN biopsy would be useful if it could accurately identify patients in whom cancer has spread to the groin, without removing all groin nodes. SLNs can be identified by isosulfan blue dye and/or technetium-99 ((99m)Tc) radioactive tracer during lymphoscintigraphy. The blue dye/(99m)Tc procedure only detects SLN, not metastases - this requires histological examination, which can include ultrastaging and staining with conventional haematoxylin and eosin (H&E) or immunohistochemistry. OBJECTIVES To determine the test accuracy and cost-effectiveness of the SLN biopsy with (99m)Tc and/or blue dye compared with IFL or clinical follow-up for test negatives in vulval cancer, through systematic reviews and economic evaluation. DATA SOURCES Standard medical databases, including MEDLINE, EMBASE, Science Citation Index and The Cochrane Library, medical search gateways, reference lists of review articles and included studies were searched to January 2011. METHODS For accuracy and effectiveness, standard methods were used and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were to January 2011, with no language restrictions. Meta-analyses were carried out with Meta-Disc version 1.4 (Javier Zamora, Madrid, Spain) for accuracy; none was appropriate for effectiveness. The economic evaluation from a NHS perspective used a decision-tree model in DATA TreeAge Pro Healthcare 2001 (TreeAge Software, Inc., Williamstown, MA, USA). Six options (blue dye with H&E, blue dye with ultrastaging, (99m)Tc with H&E, (99m)Tc with ultrastaging, blue dye/(99m)Tc with H&E, blue dye/(99m)Tc with ultrastaging) were compared with IFL. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS For accuracy, of the 26 included studies, most evaluated (99m)Tc/blue dye combined. Four studies had clinical follow-up only for test negatives and five had clinical follow-up for all and IFL for test negatives. Numbers with no SLN found were difficult to distinguish from those with negative SLN biopsies. The largest group of 11 studies using (99m)Tc/blue dye, ultrastaging and immunohistochemistry had a pooled sensitivity of 95.6% [95% confidence interval (CI) 91.5% to 98.1%] and a specificity of 100% (95% CI 99.0% to 100%). Mean SLN detection rates were 94.6% for (99m)Tc, 68.7% for blue dye and 97.7% for both. One study measured global health status quality of life (QoL) and found no difference between SLN biopsy and IFL. One patient preference evaluation showed that 66% preferred IFL rather than a 5% false-negative rate from SLN biopsy. For effectiveness, of 14,038 references, one randomised controlled trial, three case-control studies and 13 case series were found. Approximately 50% died from vulval cancer and 50% from other causes during follow-ups. Recurrences were in the ratio of approximately 4 : 2 : 1 vulval, groin and distant, with more recurrences in node-positive patients. No studies reported QoL. For cost per death averted, IFL was less costly and more effective than strategies using SLN biopsy. For morbidity-free survival and long-term morbidity-free survival, (99m)Tc with ultrastaging was most cost-effective. Strategies with blue dye only and H&E only were never cost-effective. The incremental cost-effectiveness ratio for (99m)Tc with ultrastaging compared with IFL was £4300 per case of morbidity-free survival and £7100 per long-term morbidity-free survival. LIMITATIONS The main limitations of this study include the lack of good-quality evidence on accuracy, effectiveness and QoL. A large project such as this takes time to publish, so the most recent studies are not included. CONCLUSIONS A sensitive and specific combined metastatic SLN detection test and information on generic QoL in vulval cancer is urgently required. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Meads
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London Health Economics Research Group (HERG), Brunel University Unit of Health Economics, University of Birmingham Arcana Institute Departments of Gynaecology and Gynaecological Oncology, Addenbrooke's Hospital NHS Trust Department of Gynaecology, Barts Health NHS Trust Pan Birmingham Gynaecological Cancer Centre, Birmingham Women's Hospital NHS Foundation Trust, London Middlesex Birmingham Krakow Cambridge London Birmingham, UK UK UK Poland UK UK UK
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Affiliation(s)
- Asya Fish
- Saba University School of Medicine, Devens, MA 01434, USA
| | - Farheen Shaikh
- Saba University School of Medicine, Devens, MA 01434, USA
| | - Rafael Sanchez
- Division of Trauma Services, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Sean O'Donnell
- Division of Trauma Services, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Andrew Rosenthal
- Division of Trauma Services, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - LeAnne Kerr
- Division of Trauma Services, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Seong Lee
- Division of Trauma Services, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Chauniqua Kiffin
- Division of Trauma Services, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Dafney Lubin
- Division of Trauma Services, Memorial Regional Hospital, Hollywood, FL 33021, USA
| | - Eddy Carrillo
- Division of Trauma Services, Memorial Regional Hospital, Hollywood, FL 33021, USA
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Silva-Angulo A, Zanini S, Rodrigo D, Rosenthal A, Martinez A. Growth kinetics of Listeria innocua and Listeria monocytogenes under exposure to carvacrol and the occurrence of sublethal damage. Food Control 2014. [DOI: 10.1016/j.foodcont.2013.09.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zanini SF, Silva-Angulo AB, Rosenthal A, Rodrigo D, Martínez A. Effect of citral and carvacrol on the susceptibility of Listeria monocytogenes and Listeria innocua to antibiotics. Lett Appl Microbiol 2014; 58:486-92. [PMID: 24443987 DOI: 10.1111/lam.12218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED The aim of this study was to evaluate the antibiotic susceptibility of Listeria innocua (L. innocua) and Listeria monocytogenes (L. monocytogenes) cells in the presence of citral and carvacrol at sublethal concentrations in an agar medium. The presence of terpenes in the L. monocytogenes and L. innocua culture medium provided a reduction in the minimal inhibitory concentration (MIC) of all the antibiotics tested. These effects were dependent on the concentration of terpenes present in the culture medium. The combination of citral and carvacrol potentiated antibiotic activity by reducing the MIC values of bacitracin and colistin from 32.0 and 128.0 μg ml⁻¹ to 1.0 and 2.0 μg ml⁻¹, respectively. Thus, both Listeria species became more susceptible to these drugs. In this way, the colistin and bacitracin resistance of L. monocytogenes and L. innocua was reversed in the presence of terpenes. Results obtained in this study show that the phytochemicals citral and carvacrol potentiate antibiotic activity, reducing the MIC values of cultured L. monocytogenes and L. innocua. SIGNIFICANCE AND IMPACT OF THE STUDY Phytochemicals citral and carvacrol potentiate antibiotic activity of erythromycin, bacitracin and colistin by reducing the MIC values of cultured Listeria monocytogenes and Listeria innocua. This effect in reducing the MIC values of the antibiotics tested in both micro-organisms was increased when natural antimicrobials were combined. This finding indicated that the combination among terpenes and antibiotic may contribute in reducing the required dosage of antibiotics due to the possible effect of terpenes on permeation barrier of the micro-organism cell membrane.
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Affiliation(s)
- S F Zanini
- Department of Veterinary Medicine, CNPq Postdoctoral Fellowship, Espirito Santo Federal University, Alegre, Brazil
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Abstract
The neurotrophin family is comprised of the structurally related secreted proteins nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophine-4 (NT-4). They bind and activate the tyrosine kinase receptors Trk A, B, and C in a ligand-specific manner and additionally bind a shared p75NTR receptor. The neurotrophins were originally defined by their ability to support the survival and maturation of embryonic neurons. However, they also control important physiological functions of the adult nervous system including learning and memory, sensation, and energy homeostasis. For example, NGF/trkA signaling is critical for normal and pathological sensation of pain. Likewise, the BDNF/trkB pathway controls feeding and metabolism, and its dysfunction leads to severe obesity. Antibodies can modulate neurotrophin signaling. Thus, NGF blocking agents can attenuate pain in several animal models, and a recombinant humanized NGF blocking antibody (Tanezumab) has shown promising results in human clinical trials for osteoarthritic pain. On the other hand trkB agonist antibodies can modulate food intake and body weight in rodents and nonhuman primates. The power of monoclonal antibodies to modulate neurotrophin signaling promises to turn the rich biological insights into novel human medicines.
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Affiliation(s)
- A Rosenthal
- Alector Inc., 953 Indiana St., San Francisco, CA, 94107, USA,
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Mathias SP, Rosenthal A, Gaspar A, Aragão GMF, Slongo-Marcusi A. Prediction of acid lactic-bacteria growth in turkey ham processed by high hydrostatic pressure. Braz J Microbiol 2013; 44:23-8. [PMID: 24159279 PMCID: PMC3804173 DOI: 10.1590/s1517-83822013005000014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 08/22/2012] [Indexed: 11/22/2022] Open
Abstract
High hydrostatic pressure (HHP) has been investigated and industrially applied to extend shelf life of meat-based products. Traditional ham packaged under microaerophilic conditions may sometimes present high lactic acid bacteria population during refrigerated storage, which limits shelf life due to development of unpleasant odor and greenish and sticky appearance. This study aimed at evaluating the shelf life of turkey ham pressurized at 400 MPa for 15 min and stored at 4, 8 and 12 °C, in comparison to the non pressurized product. The lactic acid bacteria population up to 10(7) CFU/g of product was set as the criteria to determine the limiting shelf life According to such parameter the pressurized sample achieved a commercial viability within 75 days when stored at 4 °C while the control lasted only 45 days. Predictive microbiology using Gompertz and Baranyi and Roberts models fitted well both for the pressurized and control samples. The results indicated that the high hydrostatic pressure treatment greatly increased the turkey ham commercial viability in comparison to the usual length, by slowing down the growth of microorganisms in the product.
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Affiliation(s)
- S P Mathias
- Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brazil
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