1
|
Sajan A, Fordyce S, Sideris A, Liou C, Toor Z, Filtes J, Krishnasamy V, Ahmad N, Reis S, Brejt S, Baig A, Khan S, Caplan M, Sperling D, Weintraub J. Minimally Invasive Treatment Options for Hepatic Uveal Melanoma Metastases. Diagnostics (Basel) 2023; 13:diagnostics13111836. [PMID: 37296688 DOI: 10.3390/diagnostics13111836] [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] [Received: 03/22/2023] [Revised: 05/01/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023] Open
Abstract
Uveal melanoma is one of the most common primary intraocular malignancies that accounts for about 85% of all ocular melanomas. The pathophysiology of uveal melanoma is distinct from cutaneous melanoma and has separate tumor profiles. The management of uveal melanoma is largely dependent on the presence of metastases, which confers a poor prognosis with a one-year survival reaching only 15%. Although a better understanding of tumor biology has led to the development of novel pharmacologic agents, there is increasing demand for minimally invasive management of hepatic uveal melanoma metastases. Multiple studies have already summarized the systemic therapeutic options available for metastatic uveal melanoma. This review covers the current research for the most prevalent locoregional treatment options for metastatic uveal melanoma including percutaneous hepatic perfusion, immunoembolization, chemoembolization, thermal ablation, and radioembolization.
Collapse
Affiliation(s)
- Abin Sajan
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Samuel Fordyce
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Andrew Sideris
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Connie Liou
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Zeeshan Toor
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - John Filtes
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Venkatesh Krishnasamy
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Noor Ahmad
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Stephen Reis
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Sidney Brejt
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Asad Baig
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Shaheer Khan
- Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Michael Caplan
- Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - David Sperling
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Joshua Weintraub
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| |
Collapse
|
2
|
Reis SP, Bruestle K, Brejt S, Tulin-Silver S, Frenkel J, Mobley DG, England RW, Sobolevsky S, Griesemer AD, Sperling D, Schlossberg P, Susman J, Weintraub JL. Evaluation of a three-session biliary dilation protocol following transplant-related biliary stricture in pediatric patients. Pediatr Transplant 2019; 23:e13551. [PMID: 31313460 DOI: 10.1111/petr.13551] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/15/2019] [Accepted: 06/16/2019] [Indexed: 12/14/2022]
Abstract
To evaluate whether a serial biliary dilation protocol improves outcomes and decreases total biliary drainage time for biliary strictures following pediatric liver transplantation. From 2006 to 2016, 213 orthotopic deceased and living related liver transplants were performed in 199 patients with a median patient age of 3.1 years at a single pediatric hospital. Patients with biliary strictures were managed by IR or surgically by the transplant team. Patients managed by IR were divided into two groups. The first group was managed with a standardized three-session protocol consisting of dilation every two weeks for three dilations. The second group was managed clinically with varying number and interval of dilations as determined by a multidisciplinary team. The location of biliary stricture, duration of drainage, number of balloon dilations, balloon diameter, time interval between dilations, and success of percutaneous treatment were recorded. Thirty-four patients developed biliary strictures. Thirty-one patients were managed with percutaneous intervention. Three strictures could not be crossed and were converted to operative management. Ten patients were managed in the three-session protocol, and 18 patients were managed in the clinically treated group. There was no significant difference in clinical success rates between groups, 80% and 61%, respectively. The three-session protocol group trended toward a lower total biliary drain indwell time (median 49 days) compared with the clinically treated group (median 89 days), P = .089. Our study suggests that a three-session dilation protocol following transplant-related biliary stricture may decrease total biliary drainage time for some patients.
Collapse
Affiliation(s)
- Stephen P Reis
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York.,Morgan Stanley Children's Hospital of New York, New York, New York
| | - Karina Bruestle
- Department of Surgery, Division of Transplant Surgery, Columbia University Irving Medical Center, New York, New York.,Columbia Center for Translational Immunology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Sidney Brejt
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York.,Morgan Stanley Children's Hospital of New York, New York, New York
| | - Sheryl Tulin-Silver
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York.,Morgan Stanley Children's Hospital of New York, New York, New York
| | - Joseph Frenkel
- Albert Einstein University College of Medicine, New York, New York
| | - David G Mobley
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York.,Morgan Stanley Children's Hospital of New York, New York, New York
| | - Ryan W England
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Sergei Sobolevsky
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York.,Morgan Stanley Children's Hospital of New York, New York, New York
| | - Adam D Griesemer
- Morgan Stanley Children's Hospital of New York, New York, New York.,Department of Surgery, Division of Transplant Surgery, Columbia University Irving Medical Center, New York, New York
| | - David Sperling
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York.,Morgan Stanley Children's Hospital of New York, New York, New York
| | - Peter Schlossberg
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York.,Morgan Stanley Children's Hospital of New York, New York, New York
| | - Jonathan Susman
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York.,Morgan Stanley Children's Hospital of New York, New York, New York
| | - Joshua L Weintraub
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York.,Morgan Stanley Children's Hospital of New York, New York, New York
| |
Collapse
|
3
|
Blackie M, Baughman KR, Palmisano B, Sanders M, Sperling D, Scott E, Radwany S, Drost J, Thomas J. Building Provider-Caregiver Partnerships: Curricula for Medical Students and Residents. Acad Med 2019; 94:1483-1488. [PMID: 31135398 DOI: 10.1097/acm.0000000000002806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PROBLEM A disconnect exists between caregivers and health care providers, resulting in fragmented communication, which increases caregiver stress and compromises patient care. Although providers have a responsibility to recognize caregiver burden, they receive scant training on issues important to caregivers. APPROACH From 2014 to 2017, as part of the Building Caregiver Partnerships Through Interprofessional Education project-a collaborative effort between Northeast Ohio Medical University and Summa Health-the authors developed curricula to foster effective partnerships between health care providers and caregivers by exposing medical students and residents to highly personal caregiving narratives. The curricula center on a short film featuring 4 families representing diverse caregiving experiences. The authors crafted several discussion guides, case-based learning exercises, structured clinical encounters, team-based simulations, and clinical cases as companion educational tools for the film. OUTCOMES Medical students reported the educational tools piloted to be valuable in broadening their understanding of caregivers' needs, while residents reported the educational tools piloted to also be valuable in improving their communication and building partnerships with caregivers. Undergraduate and graduate faculty reported finding the pilots valuable. NEXT STEPS Future goals include conducting an outcome evaluation, based on ACGME milestones, to identify and examine clinical outcomes to determine whether communication increases and quality of care improves as a result of the project. The authors would also like to include caregivers in the evaluation. Finally, because caregiving is best addressed from a team approach, the authors plan to pilot the project at other health professions programs.
Collapse
Affiliation(s)
- Michael Blackie
- M. Blackie is associate professor, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois. K.R. Baughman is associate professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. B. Palmisano is assistant professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. M. Sanders is associate professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. D. Sperling is associate professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. E. Scott is attending physician, Massachusetts General Hospital, Boston, Massachusetts. S. Radwany is professor, Departments of Medicine and Hospice and Palliative Medicine, The Ohio State University, Columbus, Ohio. J. Drost is geriatric fellowship associate program director, Senior Services, Summa Health, Akron, Ohio. J. Thomas is professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Rao N, Rizk EM, Hwang R, Gartrell RD, Makkar J, Oza J, Najjar M, Emond J, Fox A, Verna E, Brejt S, Reis S, Sheynzon V, Sperling D, Weintraub J, Saenger YM. Nivolumab for hepatocellular carcinoma (HCC) in a real-world context. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15675 Background: Novel immunotherapies may be effective in patients with HCC; however, patients with advanced liver disease are often excluded from clinical trials. The goal of our study was to evaluate the safety and efficacy of nivolumab for HCC in a real-world context, including among patients with advanced liver disease. Methods: We examined all cases of HCC initiated on off-study nivolumab alone or in combination with locoregional therapy at our institution from 2/2017 to 7/2018. Our sample included 14 patients. We report participant demographics, baseline liver function, treatment toxicity, and overall survival (OS). Results: The majority of participants were male (71%) and Caucasian (57%). NAFLD (36%) and HCV (43%) were the most frequently cited risk factors for HCC. Patients had variable liver disease at baseline, with 36% Child-Turcotte-Pugh (CTP) A, 36% CTP B, and 21% CTP C disease. Patients received either nivolumab only (50%), or nivolumab with locoregional therapy (LRT) (50%). All patients with CTP C disease received nivolumab alone. Treatment was generally safe, with only grade 1 or 2 toxicities reported, most commonly fatigue. Median OS was 7 months. Of note, one patient with baseline CTP C disease showed complete response to nivolumab treatment but experienced recurrence off nivolumab. Conclusions: Our study is the first to report the use of nivolumab in patients with HCC and CTP C disease. Nivolumab was well-tolerated in a real-world context in this small patient cohort, including among patients with advanced cirrhosis. Further study in larger patient populations is warranted. [Table: see text]
Collapse
Affiliation(s)
- Nisha Rao
- Columbia University Medical Center, New York, NY
| | | | - Regina Hwang
- Columbia University Medical Center, New York, NY
| | | | | | - Jay Oza
- Columbia University Medical Center, New York, NY
| | - Marc Najjar
- Columbia University Irving Medical Center, New York, NY
| | - Jean Emond
- Columbia University Irving Medical Center, New York, NY
| | - Alyson Fox
- Columbia University Medical Center, New York, NY
| | | | - Sidney Brejt
- Columbia University Medical Center, New York, NY
| | - Stephen Reis
- Columbia University Medical Center, New York, NY
| | | | | | | | | |
Collapse
|
5
|
Baughman KR, Palmisano B, Sanders M, Blackie M, Sperling D, Scott E, Radwany S, Drost J. Use of Film to Sensitize Medical Students to Issues of Family Caregiving. PRiMER 2019; 3:14. [PMID: 32537585 DOI: 10.22454/primer.2019.254302] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and Objective Families are the backbone of our long-term care system, managing complicated illnesses, providing direct care, and assisting with the day-to-day functioning of elderly patients. Medical education, however, provides students with little, if any, exposure to the challenges faced by family caregivers or how best to communicate with them to optimize patient care. We assessed the value of an educational program combining film and discussion as a means of sensitizing third-year medical students to caregiver issues. During their family medicine clerkship, third-year medical students at Northeast Ohio Medical University view the film, No Roadmap: Caregiver Journeys and discuss issues of family caregiving. Methods A mixed-methods approach was used to evaluate the program, including a qualitative focus group with clerkship preceptors and ongoing quantitative student evaluations. Results Preceptors reported that students related to the film in highly personal ways, often recounting experiences within their own families, and gained a greater appreciation of caregivers. Three years of student evaluations (n=403) were used to validate preceptor comments. Students agreed that the program helped them establish a comfortable relationship with caregivers, increased their awareness of caregiver challenges and rewards, and provided valuable insights into caregiver experiences. Conclusions Film depicting compelling narratives of caregiver journeys, coupled with guided discussion, is a valuable strategy for increasing student awareness of the important role of caregivers.
Collapse
Affiliation(s)
- Kristin R Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Barbara Palmisano
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Margaret Sanders
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Michael Blackie
- Department of Medical Education, University of Illinois at Chicago, College of Medicine, Chicago, IL
| | - David Sperling
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Erin Scott
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA
| | - Steven Radwany
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | | |
Collapse
|
6
|
Kim E, Alvarez L, Arnell T, Brejt S, Cooper C, Reis S, Schlossberg P, Sheynzon V, Sobolevsky S, Sperling D, Susman J, Tulin-Silver S, Weintraub J, Mobley D. 03:09 PM Abstract No. 307 The efficacy of culturing bile when placing percutaneous cholecystostomy tubes for acute cholecystitis. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.374] [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: 11/30/2022] Open
|
7
|
Gioioso V, Reis S, Brejt S, Tulin-Silver S, Sperling D, Susman J, Weintraub J, Mobley D. Abstract No. 582 Microwave ablation of osteoid osteoma: safety and efficacy. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
8
|
Abstract
Amoxicillin has become a major antimicrobial substance in pig medicine for the treatment and control of severe, systemic infections such as Streptococcus suis. The minimum inhibitory concentration 90% (MIC 90) is 0.06 μg amoxicillin/ml, and the proposed epidemiological cut-off value (ECOFF) is 0.5 μg/ml, giving only 0.7% of isolates above the ECOFF or of reduced susceptibility. Clinical breakpoints have not been set for amoxicillin against porcine pathogens yet, hence the use of ECOFFs. It has also been successfully used for bacterial respiratory infections caused by Actinobacillus pleuropneumoniae and Pasteurella multocida. The ECOFF for amoxicillin against A. pleuropneumoniae is also 0.5 μg/ml demonstrating only a reduced susceptibility in 11.3% of isolates. Similarly, P. multocida had an ECOFF of 1.0 μg/ml and a reduced susceptibility in only 2.6% of isolates. This reduced susceptibility disappears when combined with the beta-lactamase inhibitor, clavulanic acid, demonstrating that it is primarily associated with beta-lactamase production. In contrast, amoxicillin is active against Escherichia coli and Salmonella species but using ECOFFs of 8.0 and 4.0 μg/ml, respectively, reduced susceptibility can be seen in 70.9% and 67.7% of isolates. These high levels of reduced susceptibility are primarily due to beta-lactamase production also, and most of this resistance can be overcome by the combination of amoxicillin with clavulanic acid. Currently, amoxicillin alone is considered an extremely valuable antimicrobial in both human and animal medicine and remains in the critically important category of antibiotics alongside the fluoroquinolones and macrolides by the World Health Organization as well as the third- and fourth-generation cephalosporins, but these cephalosporins show marked resistance to basic beta-lactamase production and are only destroyed by the extended-spectrum beta-lactamases. Amoxicillin alone and in combination with clavulanic acid are currently classed together in Category 2 in the European Union. By reviewing the pharmacodynamic data and comparing this with pharmacokinetic data from healthy and infected animals and clinical trial data, it can be seen that the product has a good efficacy against S. suis and A. pleuropneumoniae, in spite of usage over many years. However, it may be much less efficacious on its own against E. coli, due to reduced susceptibility and resistance associated with beta-lactamase production, which is largely overcome by the use of clavulanic acid. It is felt that this differentiation may be useful in future classification of amoxicillin alone, in comparison with its combined use with clavulanic acid and thereby preserve the use of the more critically important antibiotics in veterinary medicine and reducing the risk of their resistance being transmitted to human.
Collapse
Affiliation(s)
- D G S Burch
- Octagon Services Ltd, Windsor, Berkshire, UK
| | - D Sperling
- Ceva Sante Animale, Libourne Cedex, Bordeaux, France
| |
Collapse
|
9
|
|
10
|
Dubois B, Wilcox C, Weintraub J, Susman J, Sperling D, Sheynzon V, Schlossberg P, Chheang S, Reis S, Mobley D. Efficacy and safety of partial splenic embolization in patients with splenomegaly associated cytopenias. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.755] [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: 10/20/2022] Open
|
11
|
Hanna RF, Hao F, Kraus CF, Mitsopoulos G, Goldstein GE, Weintraub J, Sperling D, Susman J, Schlossberg P, Sheynzon V. Renal Transplant Arterial Stenosis Treated With Bare-Metal Versus Drug-Eluting Stents: Comparison of Treatment Outcomes. Transplant Proc 2016; 47:2881-5. [PMID: 26707307 DOI: 10.1016/j.transproceed.2015.09.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/17/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This study aims to evaluate outcomes of bare-metal stents (BMS) versus drug-eluting stents (DES) in patients who undergo stenting for transplant renal arterial stenosis. MATERIALS AND METHODS We retrospectively reviewed records of renal transplantation patients who underwent transplant renal arterial stenting from September 2009 to September 2013. All stents greater than 5 mm were excluded to allow for equivalent comparison between the DES and BMS groups. Statistical comparisons were performed using a two-tailed Fischer exact test, and analysis of continuous variables was analyzed using a one-way analysis of variance. RESULTS The final study population included a total of 18 patients who received either BMS or DES (11 and 7 patients, respectively) for transplant renal arterial stenosis. The most common indications for stenting were increasing creatinine level and abnormal Doppler velocities. There were more re-interventions with BMS (n = 4/11) than DES (n = 0/7), but the trend was not statistically significant (P = .12). Three patients who received BMS had a clinically significant decrease in blood pressure versus 4 in the DES group (P = .33). Six patients who received BMS had a clinically significant decrease in creatinine level versus 3 in the DES group (P = 1.0). CONCLUSION There is an absolute but not statistically significant difference in the incidence of restenosis requiring repeat intervention between the BMS and DES groups. No difference was detected in clinical success as measured by decreases in blood pressure or creatinine. Future larger studies are needed to corroborate these findings.
Collapse
Affiliation(s)
- R F Hanna
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - F Hao
- Department of Radiology, Columbia University Medical Center, New York, New York.
| | - C F Kraus
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - G Mitsopoulos
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - G E Goldstein
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - J Weintraub
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - D Sperling
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - J Susman
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - P Schlossberg
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - V Sheynzon
- Department of Radiology, Columbia University Medical Center, New York, New York
| |
Collapse
|
12
|
Delucchi MA, Yang C, Burke AF, Ogden JM, Kurani K, Kessler J, Sperling D. An assessment of electric vehicles: technology, infrastructure requirements, greenhouse-gas emissions, petroleum use, material use, lifetime cost, consumer acceptance and policy initiatives. Philos Trans A Math Phys Eng Sci 2014; 372:20120325. [PMID: 24298079 DOI: 10.1098/rsta.2012.0325] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Concerns about climate change, urban air pollution and dependence on unstable and expensive supplies of foreign oil have led policy-makers and researchers to investigate alternatives to conventional petroleum-fuelled internal-combustion-engine vehicles in transportation. Because vehicles that get some or all of their power from an electric drivetrain can have low or even zero emissions of greenhouse gases (GHGs) and urban air pollutants, and can consume little or no petroleum, there is considerable interest in developing and evaluating advanced electric vehicles (EVs), including pure battery-electric vehicles, plug-in hybrid electric vehicles and hydrogen fuel-cell electric vehicles. To help researchers and policy-makers assess the potential of EVs to mitigate climate change and reduce petroleum use, this paper discusses the technology of EVs, the infrastructure needed for their development, impacts on emissions of GHGs, petroleum use, materials use, lifetime costs, consumer acceptance and policy considerations.
Collapse
Affiliation(s)
- M A Delucchi
- Institute of Transportation Studies, University of California, , Davis, 1605 Tilia Street, Davis, CA 95616, USA
| | | | | | | | | | | | | |
Collapse
|
13
|
Gandhi AD, Saleem A, Sperling D, Piccorelli GO. Leptomeningitis: a rare outcome after cervical stab wound. J Trauma 2010; 68:E57-E60. [PMID: 20220401 DOI: 10.1097/ta.0b013e318166d754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Alok D Gandhi
- Departments of Surgery, St. Barnabas Hospital, Bronx, New York, USA.
| | | | | | | |
Collapse
|
14
|
Fieg G, Rümmeli N, Sperling D, Johannink M. Experimentelle Untersuchungen der Extraktion von Resveratrol aus Wurzeln Polygonum Cuspidatum. CHEM-ING-TECH 2008. [DOI: 10.1002/cite.200750584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
15
|
Karmy-Jones R, Jurkovich GJ, Velmahos GC, Burdick T, Spaniolas K, Todd SR, McNally M, Jacoby RC, Link D, Janczyk RJ, Ivascu FA, McCann M, Obeid F, Hoff WS, McQuay N, Tieu BH, Schreiber MA, Nirula R, Brasel K, Dunn JA, Gambrell D, Huckfeldt R, Harper J, Schaffer KB, Tominaga GT, Vinces FY, Sperling D, Hoyt D, Coimbra R, Rosengart MR, Forsythe R, Cothren C, Moore EE, Haut ER, Hayanga AJ, Hird L, White C, Grossman J, Nagy K, Livaudais W, Wood R, Zengerink I, Kortbeek JB. Practice Patterns and Outcomes of Retrievable Vena Cava Filters in Trauma Patients: An AAST Multicenter Study. ACTA ACUST UNITED AC 2007; 62:17-24; discussion 24-5. [PMID: 17215729 DOI: 10.1097/ta.0b013e31802dd72a] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF). METHODS A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve. RESULTS Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 +/- 8 days after admission and retrieval at 50 +/- 61 days. Follow up after discharge (5.7 +/- 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R). CONCLUSION Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined.
Collapse
|
16
|
Strunk B, Shaw RE, Bull S, Adams J, Baer M, Gershengorn K, Kao A, Keeffe B, Sklar J, Sperling D, Sperling R, Wexman M, Young J. High incidence of focal left ventricular wall motion abnormalities and normal coronary arteries in patients with myocardial infarctions presenting to a community hospital. J Invasive Cardiol 2006; 18:376-81. [PMID: 16877787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Myocardial infarction with normal coronary arteries (MINCA) is a well-documented syndrome often associated with global left ventricular wall motion abnormalities (LVWMAs). Recent literature has emphasized the occurrence of Takotsubo cardiomyopathy associated with MINCA. What has not been reported is the incidence of MINCA in the general population and the relative frequency of other types of associated LVWMAs. METHODS AND RESULTS Data were retrospectively collected on 165 consecutive patients with ST-elevation myocardial infarction (STEMI) and 244 patients with non-ST-elevation myocardial infarction (NSTEMI) who underwent cardiac catheterization at a single institution in Marin County, California. Thirty-two of the 409 (7.8%) patients had MINCA. Of the patients presenting with STEMI, 10.3% had MINCA, and 6.1% of the patients presenting with NSTEMI had MINCA. Females were more likely to present with MINCA than males, both for STEMI (21.6% vs. 5.3%; p < 0.001) and NSTEMI (12.1% vs. 2.6%; p < 0.001). Of the 32 patients who presented with MINCA, 7 (21.9%) females had Takotsubo cardiomyopathy, while 10 (31.3%) patients (9 females, 1 male) had other previously undescribed focal anterior and inferior LVWMAs. A recent stressful event was noted in 50% (47.8% of females, 55.6% of males) of the patients with MINCA. CONCLUSIONS An unexpectedly high incidence of MINCA with newly-described focal anterior and inferior LVWMAs as well as Takotsubo cardiomyopathy was observed in our community hospital. This syndrome occurred predominantly in females and was often associated with a recent stressful event. As these results were from a community, rather than a referral hospital, this finding challenges the current thought about the incidence of this syndrome in the general population.
Collapse
Affiliation(s)
- Brian Strunk
- Marin General Hospital, Marin County, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Sher L, Sperling D, Zalsman G, Vardi G, Merrick J. Alcohol and suicidal behavior in adolescents. Minerva Pediatr 2006; 58:333-9. [PMID: 17008841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This review describes epidemiology, pathophysiology, risk factors, treatment and prevention of suicidal behavior in adolescents. As one of the leading causes of death of young adults, adolescent suicide has become a public health problem and an increase in the adolescent suicide rate has been observed over the past several decades. One important risk factor thought to contribute to the recent rise in suicidal behavior among young adults is increasing alcohol abuse among adolescents. The link between alcohol and suicide in adolescents is complicated and multiple risk factors are important in explaining and understanding suicidal behavior among adolescents. Comorbid psychopathology, which is common among adolescent alcohol abusers, substantially increases the risk for suicide behavior. Availability of alcohol and guns at home may also contribute to suicide risk in adolescents. Studies of stress hormones, brain neurotransmitters, hereditary factors, behavioral measures and gender differences shed light in understanding this complex phenomenon. Ideally, treatment of adolescents who receive a diagnosis of an alcohol use disorder and co-occurring suicidality should follow an integrated protocol that addresses both conditions. Future studies of psychological and neurobiological mechanisms of suicidality in adolescents with alcohol and/or substance abuse are merited.
Collapse
Affiliation(s)
- L Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, NY, USA
| | | | | | | | | |
Collapse
|
18
|
Birkedal C, Tapscott WJ, Giadrosich K, Spence RK, Sperling D. Minocycline-induced black thyroid gland: Medical curiosity or a marker for papillary cancer? ACTA ACUST UNITED AC 2001; 58:470-1. [PMID: 16093068 DOI: 10.1016/s0149-7944(01)00476-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Black pigmentation of the thyroid gland is a rare side effect of minocycline. METHODS Only 26 cases, in addition to the 2 we present, have been reported in the literature. Eleven cases of thyroid carcinoma associated with black thyroid syndrome have been reported. CONCLUSIONS The incidence of papillary cancer may be increased in thyroid glands stained by the minocycline pigment, which warrants an increased index of suspicion in patients who develop thyroid nodules and have previously been treated with minocycline.
Collapse
Affiliation(s)
- C Birkedal
- Department of Surgery, Baptist Health Systems, Birmingham, Alabama, USA
| | | | | | | | | |
Collapse
|
19
|
Affiliation(s)
- D Sperling
- Institut für Mikrobiologie und Biotechnologie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn D-53115, Germany
| | | | | | | |
Collapse
|
20
|
Affiliation(s)
- J Bonn
- Department of Radiology, Jefferson Medical College and Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | | | | | | |
Collapse
|
21
|
Abstract
The synthesis of paclitaxel esters of malic acid is described. These compounds were found to have improved water solubility and are stable in solution at neutral pH. The C2' modified compounds behave as prodrugs, that is, paclitaxel is generated upon exposure to human plasma, whereas the C7 modified derivatives do not. 2'-Malyl paclitaxel sodium salt demonstrated enhanced antitumour activity and less toxicity in a P388 murine leukaemia in vivo model when compared to paclitaxel.
Collapse
Affiliation(s)
- E W Damen
- Department of Organic Chemistry, NSR Center for Molecular Structure, Design and Synthesis, University of Nijmegen, Toernooiveld, The Netherlands
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
Tuberous sclerosis (TSC) is a dominantly inherited disorder due to mutations at two gene loci, the TSC1 locus on chromosome 9q34 and the TSC2 locus on chromosome 16p13.3. The TSC2 and the TSC1 genes have now been cloned, enabling mutation analysis. We report results of mutation analysis in a sporadic case of TSC first identified in intra-uterine life on the basis of the presence of cardiac rhabdomyomas. Postnatally this infant was also found to have subependymal nodules on brain computed tomographic scan. Hypomelanotic macules were not detected neonatally or at 12 months of age. The specific TSC1 exon 15 mutation found in our patient has not previously been reported in cases of TSC. This mutation involves duplication of a 23-bp segment of DNA between two 9-bp repeated sequence elements within exon 15. These repeat elements are located between nucleotides 1892-1900 and between nucleotides 1915-1923 within the TSC1 gene sequence. It is likely that the presence of these two repeated elements predisposes to misalignment of DNA strands and unequal crossing over. The mechanism of origin of rhabdomyomas in TSC is reviewed. Loss of heterozygosity in the TSC gene regions has been reported in cardiac rhabdomyomas; however, these lesions are self-limiting in their growth. The basis for this self limiting proliferation is not clear. One interesting postulation is that cardiac rhabdomyomas may be due to delay or failure of apoptosis which occurs as part of the normal remodeling process in the heart.
Collapse
Affiliation(s)
- M Smith
- Department of Pediatrics, University of California, Irvine 92697-4475, USA
| | | |
Collapse
|
23
|
Skatchkov MP, Sperling D, Hink U, Mülsch A, Harrison DG, Sindermann I, Meinertz T, Münzel T. Validation of lucigenin as a chemiluminescent probe to monitor vascular superoxide as well as basal vascular nitric oxide production. Biochem Biophys Res Commun 1999; 254:319-24. [PMID: 9918836 DOI: 10.1006/bbrc.1998.9942] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lucigenin has been widely used as a chemiluminescent substrate to monitor vascular superoxide (O*-2) formation. The validity of lucigenin for detection of O*-2 has been questioned because O*-2 is generated by lucigenin itself. It has been shown that the concentration of lucigenin is a critical parameter affecting the validity of this assay. In the present studies we evaluated a reduced concentration of lucigenin (5 microM) as a tool to quantify O*-2 production in vascular tissue. Lucigenin-induced effects on endothelial function were assessed by isometric tension recording of isolated aortic rings suspended in organ baths. The effects of lucigenin on O*-2 production were studied using spin trapping and electron spin resonance spectroscopy. Lucigenin at 250 microM but not at 5 microM caused a significant attenuation of endothelium-dependent relaxations to acetylcholine, which was prevented by pretreatment with superoxide dismutase. Spin-trapping studies revealed that lucigenin at 250 microM increased vascular O*-2 production several fold while 5 microM lucigenin did not stimulate O*-2 production. Inhibition of NO synthase by NG-momomethyl-l-arginine as well as the removal of the endothelium almost doubled lucigenin-derived chemiluminescence (LDCL), indicating that basal production of endothelium-derived NO depresses the baseline chemiluminescence signal. Thus, lucigenin at a concentration of 5 microM seems to be a sensitive and valid probe for assessing O*-2 in vascular tissue. It can also be used as an indirect probe to estimate basal vascular NO release.
Collapse
Affiliation(s)
- M P Skatchkov
- Division of Cardiology, Department of Internal Medicine, University Hospital Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Skatchkov MP, Sperling D, Hink U, Anggard E, Münzel T. Quantification of superoxide radical formation in intact vascular tissue using a Cypridina luciferin analog as an alternative to lucigenin. Biochem Biophys Res Commun 1998; 248:382-6. [PMID: 9675145 DOI: 10.1006/bbrc.1998.8963] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lucigenin has been frequently used for the chemiluminescent detection of superoxide (*O-2) in intact tissue. More recent studies, however, revealed that lucigenin per se causes formation of *O-2 raising doubt about this probe to detect reliably *O-2. We therefore tested a more recently described chemiluminescence probe (2-methyl-6-phenyl-3,7-dihydroimidazol[1,2-alpha]pyrazine-3-one (CLA)) to estimate the ability of vascular tissue to generate *O-2 as an alternative to lucigenin. In a cell free system as well as in vascular tissue, CLA-enhanced chemiluminescence was dose dependently inhibited by superoxide dismutase (SOD), vitamin C and sodium nitroprusside (SNP). Electron spin resonance studies revealed that lucigenin (250 microM) but not CLA (1 microM) caused extra *O-2 production in vascular tissue. Stimulation of vessels with NADH (200 microM) increased CLA enhanced chemiluminescence, which was inhibited by low concentrations of superoxide dismutase (20U/ml). Endothelial removal as well as the nitric oxidase-synthase inhibitor increased CLA chemiluminescence in vessels. We conclude that CLA is a sensitive and specific chemiluminescence probe to detect *O-2 production in intact vascular tissue.
Collapse
Affiliation(s)
- M P Skatchkov
- Division of Cardiology, University Hospital Eppendorf, Hamburg, 20246, Germany
| | | | | | | | | |
Collapse
|
25
|
Sperling D, Kappler U, Wynen A, Dahl C, Trüper HG. Dissimilatory ATP sulfurylase from the hyperthermophilic sulfate reducer Archaeoglobus fulgidus belongs to the group of homo-oligomeric ATP sulfurylases. FEMS Microbiol Lett 1998; 162:257-64. [PMID: 9627961 DOI: 10.1111/j.1574-6968.1998.tb13007.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In the hyperthermophilic sulfate reducer Archaeoglobus fulgidus DSM 4304T, two open reading frames (sat and ORF2) are located upstream of the aprBA genes encoding adenosine-5'-phosphosulfate (APS) reductase. sat-ORF2-aprBA probably form a transcriptional unit, since sat is preceded by putative promoter sequences and termination signals are found downstream of aprA. While the 117-residue ORF2 product does not show significant similarity to known proteins, the 456-residue, 52.78-kDa, sat-encoded polypeptide exhibits similarity to the homo-oligomeric adenosine triphosphate (ATP) sulfurylases from sulfur-oxidizing bacteria and from sulfate-assimilating bacteria and eukaryotes. Functional overexpression of sat in Escherichia coli proved that the encoded protein acts as an ATP sulfurylase. The recombinant protein was purified to homogeneity and found to be a homo-dimer. Comparison of sulfate and thiosulfate grown A. fulgidus revealed that ATP sulfurylase and APS reductase are constitutive enzymes. Distance matrix analyses allowed insights into the evolution of prokaryotic ATP sulfurylases.
Collapse
Affiliation(s)
- D Sperling
- Institut für Mikrobiologie und Biotechnologie, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | | | | | | | | |
Collapse
|
26
|
|
27
|
|
28
|
Abstract
A 4.5-month-old infant with transposition of great vessels and large ventricular septal defect developed acute infective endocarditis following cardiac catheterization. Beta-hemolytic streptococcus was recovered from three blood cultures. The infant survived after 6 weeks intravenous antibiotic therapy. The occurrence of infective endocarditis following cardiac catheterization during infancy is briefly reviewed and discussed. The importance of distinguishing febrile episodes of infancy from infective endocarditis and the use of two-dimensional echocardiography for diagnosis is re-emphasized.
Collapse
|
29
|
|
30
|
Berns MW, Wile A, Dahlman A, Johnson F, Burns R, Sperling D, Guiltinan M, Siemens A, Walter R, Hammer-Wilson M. Cellular uptake, excretion and localization of hematoporphyrin derivative (HPD). Adv Exp Med Biol 1983; 160:139-50. [PMID: 6220570 DOI: 10.1007/978-1-4684-4406-3_14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
31
|
Berns MW, Dahlman A, Johnson FM, Burns R, Sperling D, Guiltinan M, Siemens A, Walter R, Wright W, Hammer-Wilson M, Wile A. In vitro cellular effects of hematoporphyrin derivative. Cancer Res 1982; 42:2325-9. [PMID: 6210430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Several in vitro cell systems were exposed to hematoporphyrin derivative (HPD): established lines of rat kangaroo epithelial kidney; normal mouse embryonic fibroblasts; and differentiated neonatal rat myocardial cells. The uptake of HPD (25 to 100 micrograms/ml) by individual cells occurred rapidly over a 2-hr period and leveled off by 24 hr. HPD was excreted from cells by 48 hr after exposure. However, a low level of HPD (above background) was maintained in cells for up to 4 days following cessation of exposure. Intracellular binding of HPD was to mitochondria as demonstrated by fluorescence microscopy. HPD was also shown to have a growth-inhibiting effect on rat kangaroo cells without added light. The growth effects on mouse cells were less marked.
Collapse
|
32
|
Sperling D. Hospital controls save $3.1 billion. Bus Insur 1980; 14:1, 40. [PMID: 10273225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
33
|
Sperling D. Seamen health guides may cut costs. Bus Insur 1980; 14:2, 10. [PMID: 10247446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|