1
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Han JK, Perkins J, Lerner D, Yim MT, Ishii LE. Comparison of nasal valve dysfunction treatment outcomes for temperature-controlled radiofrequency and functional rhinoplasty surgery: a systematic review and meta-analyses. Rhinology 2024:3151. [PMID: 38217624 DOI: 10.4193/rhinrhin23.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND Nasal valve dysfunction (NVD) is a substantial contributor to nasal airway obstruction. Minimally-invasive temp-erature-controlled radiofrequency (TCRF) treatment of the nasal valve is available and comparison with surgical techniques is warranted. METHODOLOGY Databases: Medline (PubMed), Embase, Cochrane Library. POPULATION adults with preprocedural nasal obstruction symptom evaluation (NOSE) score ≥45. Treatment effects were derived from a random effects model and reported as weighted mean difference in NOSE score between baseline; 3, 6, and 12 months postprocedure. RESULTS Of 2529 initial articles, 5 studies describing TCRF treatment and 63 studies describing functional rhinoplasty were included. Pooled effect sizes for TCRF treatment and functional rhinoplasty were comparable in all analyses. CONCLUSIONS TCRF treatment of the internal nasal valve for NVD was associated with sustained effects comparable to functional rhinoplasty addressing the nasal valve only, rhinoplasty without concomitant turbinate treatment, and all rhinoplasty.
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Affiliation(s)
- J K Han
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J Perkins
- Independent Clinical Researcher, Sunnyvale, CA, USA
| | - D Lerner
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M T Yim
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health, Shreveport, LA, USA
| | - L E Ishii
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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2
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Han JK, Perkins J, Lerner D, Yim MT, Ishii LE. Comparison of nasal valve dysfunction treatment outcomes for temperature-controlled radiofrequency and functional rhinoplasty surgery: a systematic review and meta-analyses. Rhinology 2024; 0:3151. [PMID: 38217624 DOI: 10.4193/rhin23.261] [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: 03/08/2024]
Abstract
BACKGROUND Nasal valve dysfunction (NVD) is a substantial contributor to nasal airway obstruction. Minimally-invasive temp-erature-controlled radiofrequency (TCRF) treatment of the nasal valve is available and comparison with surgical techniques is warranted. METHODOLOGY Databases: Medline (PubMed), Embase, Cochrane Library. POPULATION adults with preprocedural nasal obstruction symptom evaluation (NOSE) score ≥45. Treatment effects were derived from a random effects model and reported as weighted mean difference in NOSE score between baseline; 3, 6, and 12 months postprocedure. RESULTS Of 2529 initial articles, 5 studies describing TCRF treatment and 63 studies describing functional rhinoplasty were included. Pooled effect sizes for TCRF treatment and functional rhinoplasty were comparable in all analyses. CONCLUSIONS TCRF treatment of the internal nasal valve for NVD was associated with sustained effects comparable to functional rhinoplasty addressing the nasal valve only, rhinoplasty without concomitant turbinate treatment, and all rhinoplasty.
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Affiliation(s)
- J K Han
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J Perkins
- Independent Clinical Researcher, Sunnyvale, CA, USA
| | - D Lerner
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M T Yim
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health, Shreveport, LA, USA
| | - L E Ishii
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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3
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Ginzburg G, Bujarska M, Moe D, Lerner D, Noe J, Chugh A. Diverticular Gastric Outpouching: A Rare Complication of Helicobacter pylori. J Pediatr Gastroenterol Nutr 2023; 77:e114. [PMID: 37548482 DOI: 10.1097/mpg.0000000000003906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- Gila Ginzburg
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Malgorzata Bujarska
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - David Moe
- Division of Pediatric Radiology, Department of Radiology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Diana Lerner
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Joshua Noe
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Ankur Chugh
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
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4
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McSorley B, Chugh A, Abazi T, Lerner D, Jobe S, Pan AY, Zhang L, Sharma R, Ashai-Khan F. Implementation of a Bleeding Risk Screening Tool and Hematology Referral Process Prior to Pediatric Endoscopy. J Pediatr Gastroenterol Nutr 2023; 77:661-665. [PMID: 37608441 DOI: 10.1097/mpg.0000000000003929] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Gastrointestinal (GI) endoscopic procedures are considered low risk with an overall bleeding risk for upper and lower endoscopies of 0.11%. However, a certain population of patients may have a higher risk for bleeding, and there is not a standardized process for screening patients to determine who these patients are. METHODS At Children's Wisconsin, our gastroenterology and hematology divisions adapted an abbreviated version of a validated, history-based bleeding risk screening tool and implemented a hematology referral process to identify those at risk for bleeding prior to their first endoscopy. Provider compliance with the bleeding screen, referral to hematology, time to be seen in hematology clinic, new diagnoses of bleeding disorders, and bleeding complications were assessed from 2019 to 2021 across 3 phases. RESULTS Provider compliance with the bleeding screen improved throughout our study from 48% (120/251) to 75% (189/253). For those who screened positive, compliance with referral to hematology ranged from 38% to 74% across our phases. The overall time to be seen by hematology decreased from 30 days to 7.5 days. Eighteen patients ultimately screened positive and were seen in hematology clinic, of whom 22% (4/18) were diagnosed with a new bleeding disorder. No bleeding complications were seen in our study population. CONCLUSIONS Our quality improvement project provided a standardized screening tool to assess preoperative bleeding risk and reinforced the value of a history-based screening tool. This modified screening tool identified those with an undiagnosed bleeding disorder and preventative measures were undertaken to prevent procedural bleeding complications.
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Affiliation(s)
- Brianna McSorley
- From the Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI
| | - Ankur Chugh
- From the Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI
| | - Tea Abazi
- From the Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI
| | - Diana Lerner
- From the Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI
| | - Shawn Jobe
- the Center for Bleeding and Clotting Disorders, Michigan State University College of Human Medicine, East Lansing, MI
| | - Amy Y Pan
- the Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Liyun Zhang
- the Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Ruchika Sharma
- the Division of Pediatric Hematology/Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Farhat Ashai-Khan
- From the Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI
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5
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Melgaço AH, Tavares RCBS, Lima LBA, Schramm MT, Horn PRCB, Maradei SC, Gomes BE, Gutiyama LM, Lerner D, Fernandez TS. TYROSINE KINASE INHIBITORS MANAGEMENT AFTER ALLOGENEIC STEM CELL TRANSPLANTATION FOR PH+ ALL: LESSONS FROM A PEDIATRIC CHALLENGING CASE. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.535] [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: 11/05/2022] Open
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6
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Affiliation(s)
- Anam Bashir
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Mariko Suchi
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Alfonso M Martinez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Diana Lerner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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7
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Affiliation(s)
- Jonathan Wong
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI
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8
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Knight B, Anderson L, Lerner D, Phelan R, Thakar MS. Case Series: Development of Polyps as a Late Effect After Total Body Irradiation-based Hematopoietic Cell Transplantation in Children With High-risk Leukemia. J Pediatr Hematol Oncol 2021; 43:e1159-e1163. [PMID: 33828034 PMCID: PMC8492786 DOI: 10.1097/mph.0000000000002152] [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: 07/17/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
Advancements in hematopoietic cell transplantation (HCT) have led to increased survivorship rates in many childhood diseases. However, this growing group of long-term survivors face a myriad of late effects. There are currently limited guidelines for surveillance of gastrointestinal polyps for pediatric transplant patients. Here we describe 5 patients undergoing HCT with total body irradiation-based conditioning regimens for leukemia who developed symptomatic polyps a median of 4.5 (range: 0.75 to 5.75) years after HCT. Because of limited surveillance guidelines in children, we conclude that the development of new or progressive symptoms related to the gastrointestinal tract deserves prompt recognition and evaluation.
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Affiliation(s)
- Benjamin Knight
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Lynnette Anderson
- Division of Pediatric Hematology-Oncology-Transplant, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Diana Lerner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Rachel Phelan
- Division of Pediatric Hematology-Oncology-Transplant, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
- Center for International Blood and Marrow Transplantation, Milwaukee, WI
| | - Monica S. Thakar
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
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9
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Funke VAM, Lima ACM, Hamerschlak N, Colturato V, Souza MP, Vigorito AC, Teixeira GM, Rocha VG, Mariano LCB, Lerner D, Barros GMN, Pasquini R, Paz AA, Neves HRA, Simioni AJ, Silva CC, Martins V, Voltarelli CL, Tan BC, Flowers ME. ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT FOR MYELOFIBROSIS IN BRAZIL: FACING OUR CHALLENGES. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.418] [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
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10
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Glait M, Wong J, Krasaelap A, Wagner A, Lal D, Schneider J, Lerner D. Esophageal Wound Vacuum Placement for Anastomotic Leak: Lessons Learned From First Time Use at a Tertiary Care Center. JPGN Rep 2021; 2:e114. [PMID: 37205950 PMCID: PMC10191559 DOI: 10.1097/pg9.0000000000000114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/15/2021] [Indexed: 05/21/2023]
Abstract
Esophageal atresia and tracheoesophageal fistula (TEF) are rare birth anomalies typically requiring corrective surgery over the first few months of life. Esophageal surgery can lead to a life-threatening anastomotic leak. Esophageal wound vacuums have seen increased use in adults and one cohort of children as a therapeutic modality. This case study explores a tertiary care pediatric hospital's introductory experience in utilizing this technique. A 19-month-old male underwent staged repair for esophageal atresia/tracheoesophageal fistula requiring an esophageal stricture resection with primary anastomosis. An anastomotic leak was successfully managed with wound vacuums. Our experiences highlighted the need for individualized treatment plans with this therapy based on feeding capabilities, side effects of the vacuum, placement method, and replacement strategies.
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Affiliation(s)
- Megan Glait
- From the Medical College of Wisconsin, Wauwatosa, WI
| | - Jonathan Wong
- From the Medical College of Wisconsin, Wauwatosa, WI
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Wisconsin, Milwaukee, WI
| | | | - Amy Wagner
- From the Medical College of Wisconsin, Wauwatosa, WI
- Division of Pediatric Surgery, Children’s Hospital of Wisconsin, Milwaukee, WI
| | - Dave Lal
- From the Medical College of Wisconsin, Wauwatosa, WI
- Division of Pediatric Surgery, Children’s Hospital of Wisconsin, Milwaukee, WI
| | - John Schneider
- From the Medical College of Wisconsin, Wauwatosa, WI
- Division of Pediatric Surgery, Children’s Hospital of Wisconsin, Milwaukee, WI
| | - Diana Lerner
- From the Medical College of Wisconsin, Wauwatosa, WI
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Wisconsin, Milwaukee, WI
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11
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Wong J, Taylor S, Lerner D. Role of sodium bicarbonate in the management of acute upper gastrointestinal bleeding. Endoscopy 2021; 53:E155-E156. [PMID: 32818996 DOI: 10.1055/a-1220-5957] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jonathan Wong
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Susan Taylor
- Division of Pediatric Anesthesia, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Diana Lerner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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12
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Brief J, Chawla A, Lerner D, Vitola B, Woroniecki R, Morganstern J. The Impact of a Smartphone App on the Quality of Pediatric Colonoscopy Preparations: Randomized Controlled Trial. JMIR Pediatr Parent 2020; 3:e18174. [PMID: 33170131 PMCID: PMC7685924 DOI: 10.2196/18174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Smartphone apps have been successfully used to help adults prepare for colonoscopies. However, no study to date has investigated the effect of a smartphone app on pediatric colonoscopy preparation. OBJECTIVE The aim of this study is to determine if an app (SB Colonoscopy Prep) designed to educate and guide patients through their colonoscopy preparation will yield benefits over paper-based instructions and information. METHODS In total, 46 patients aged 5-18 years received either app-based or written material with instructions on how to take their prep medications as well as information about the colonoscopy procedure. Prep quality, the number of calls to the gastroenterology service, and patient arrival time were recorded. After the procedure, a questionnaire was given to each patient through which they graded their knowledge of the procedure both before and after receiving the app or written material. RESULTS App users had higher mean Boston scores versus control subjects receiving written instructions (7.2 vs 5.9, P=.02), indicating better colonoscopy preps. In total, 75% (15/20) of app users and 41% (9/22) of written instruction users had preps categorized as "excellent" on the Boston scale. We found no significant differences in knowledge about the procedure (app users: 10/20 [50%], written instruction users 8/22 [36%]; P=.37), phone calls to the gastroenterology clinic (n=6 vs n=2; P=.27), or arrival times at the endoscopy suite (44 min vs 46 min before the scheduled procedure time; P=.56). CONCLUSIONS Smartphone app use was associated with an increased number of colonoscopy preps classified as "excellent" on the Boston scale. There was no significant difference between app users and the control group regarding the number of calls to the gastroenterology clinic, patient arrival time, or patient knowledge about the procedure. TRIAL REGISTRATION ClinicalTrials.gov NCT04590105; https://clinicaltrials.gov/ct2/show/NCT04590105.
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Affiliation(s)
- James Brief
- Department of Pediatric Gastroenterology, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Anupama Chawla
- Department of Pediatric Gastroenterology, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Diana Lerner
- Department of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Bernadette Vitola
- Department of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Robert Woroniecki
- Department of Pediatric Nephrology, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Jeffrey Morganstern
- Department of Pediatric Gastroenterology, Stony Brook Children's Hospital, Stony Brook, NY, United States
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13
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Oliveira J, Assumpção M, Lerner D, Colares M, Silva A. ANEMIA APLÁSICA SEVERA: ASSOCIAÇÃO DE AGONISTA DE TROMBOPOETINA AO TRATAMENTO IMUNOSSUPRESSOR EM 1ª LINHA. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.003] [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: 10/23/2022] Open
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14
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Reyes A, Tureson K, Arias J, Peraza J, Gonzalez DA, Lerner D, Santos C. Barriers and Concerns Regarding Board Certification in Clinical Neuropsychology: A Program Evaluation. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.71] [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: 11/12/2022] Open
Abstract
Abstract
Objective
The Relevance 2050 Initiative’s Student Pipeline Subcommittee and the Board Certification Promotion Committee of the American Academy of Clinical Neuropsychology, in collaboration with the American Board of Clinical Neuropsychology, produced the first installment of a free webinar series to promote early education on board certification (BC) in clinical neuropsychology. A pre-webinar survey was given to inform future webinar topics and initiatives, including identification of specific barriers/concerns about BC.
Method
A total of 197 respondents completed the survey and self-identified as White (61%), Asian (16%), Hispanic (11%), African American (6%) and Multiracial (6%). Respondents’ demographics, type of doctoral program, program accreditation status, level of interest in pursuing BC, and specific barriers/concerns about BC were collected. Respondents self-identified with the following diverse groups: first-generation college student (19% White, 38% Asian, 18% Hispanic, 16% African American, 41% Multiracial), low SES (8% White, 6% Asian, 36% Hispanic, 33% African American, 33% Multiracial) and sexual gender minority (6% White, 6% Asian, 9% Hispanic, 43% Multiracial).
Outcomes
Qualitative data analysis of barriers/concerns identified the following themes: money, time, knowledge about BC, training flexibility, breadth of knowledge, training/mentor opportunities, international issues, and documentation. The top three barriers included training/mentor opportunities, training flexibility, and knowledge about BC. More than half of non-White trainees (60%; χ2 = 3.864, p = .049) endorsed training/mentor opportunities as a barrier relative to White trainees (41%), particularly among Hispanic trainees (82%) relative to other minority trainees.
Discussion
Results highlight the need to increase awareness and information about the BC. Also suggested is prioritization of resources for training/mentor opportunities, particularly for minority trainees.
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15
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Cole S, Lerner D. Caustic Ingestions in Children. Curr Pediatr Rep 2018. [DOI: 10.1007/s40124-018-0156-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Gumidyala AP, Greenley RN, Plevinsky JM, Poulopoulos N, Cabrera J, Lerner D, Noe JD, Walkiewicz D, Werlin S, Kahn SA. Moving On: Transition Readiness in Adolescents and Young Adults With IBD. Inflamm Bowel Dis 2018; 24:482-489. [PMID: 29462383 DOI: 10.1093/ibd/izx051] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) often begins early in life. Adolescents and young adults (AYA) with IBD have to acquire behaviors that support self-care, effective healthcare decision-making, and self-advocacy to successfully transition from pediatric to adult health care. Despite the importance of this critical time period, limited empirical study of factors associated with transition readiness in AYA exists. This study aimed to describe transition readiness in a sample of AYA with IBD and identify associated modifiable and nonmodifiable factors. METHODS Seventy-five AYA (ages 16-20) and their parents participated. AYA and parents reported on demographics, patient-provider transition-related communication, and transition readiness. AYA self-reported on disease self-efficacy. Disease information was abstracted from the medical record. RESULTS Deficits in AYA responsibility were found in knowledge of insurance coverage, scheduling appointments, and ordering medication refills. Older AYA age, higher AYA disease-management self-efficacy, and increased patient-provider transition communication were each associated with higher overall transition readiness and AYA responsibility scores. Regression analyses revealed that older AYA age and increased patient-provider transition-related communication were the most salient predictors of AYA responsibility for disease management and overall transition readiness across parent and AYA reports. CONCLUSIONS AYA with IBD show deficits in responsibility for their disease management that have the potential to affect their self-management skills. Findings suggest provider communication is particularly important in promoting transition readiness. Additionally, it may be beneficial to wait to transition patients until they are older to allow them more time to master skills necessary to responsibly manage their own healthcare.
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Affiliation(s)
| | - Rachel N Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Jill M Plevinsky
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Natasha Poulopoulos
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Jose Cabrera
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Diana Lerner
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Joshua D Noe
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Dorota Walkiewicz
- Department of Pediatric Gastroenterology, UW Health, American Family Children's Hospital, Madison, WI
| | - Steven Werlin
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Stacy A Kahn
- Inflammatory Bowel Disease Center, Boston's Children's Hospital, Boston, MA
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17
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Affiliation(s)
- Julia Fritz
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, United States
| | - Alfonso Martinez
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, United States
| | - Marjorie Arca
- Department of Pediatric General Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, United States
| | - Diana Lerner
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, United States
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18
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Liu TC, Gurram B, Baldridge MT, Head R, Lam V, Luo C, Cao Y, Simpson P, Hayward M, Holtz ML, Bousounis P, Noe J, Lerner D, Cabrera J, Biank V, Stephens M, Huttenhower C, McGovern DP, Xavier RJ, Stappenbeck TS, Salzman NH. Paneth cell defects in Crohn's disease patients promote dysbiosis. JCI Insight 2016; 1:e86907. [PMID: 27699268 DOI: 10.1172/jci.insight.86907] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Paneth cell dysfunction has been implicated in a subset of Crohn's disease (CD) patients. We previously stratified clinical outcomes of CD patients by using Paneth cell phenotypes, which we defined by the intracellular distribution of antimicrobial proteins. Animal studies suggest that Paneth cells shape the intestinal microbiome. However, it is unclear whether Paneth cell phenotypes alter the microbiome complexity in CD subjects. Therefore, we analyzed the correlation of Paneth cell phenotypes with mucosal microbiome composition and ileal RNA expression in pediatric CD and noninflammatory bowel disease (non-IBD) patients. METHODS Pediatric CD (n = 44) and non-IBD (n = 62) patients aged 4 to 18 were recruited prior to routine endoscopic biopsy. Ileal mucosal samples were analyzed for Paneth cell phenotypes, mucosal microbiome composition, and RNA transcriptome. RESULTS The prevalence of abnormal Paneth cells was higher in pediatric versus adult CD cohorts. For pediatric CD patients, those with abnormal Paneth cells showed significant changes in their ileal mucosal microbiome, highlighted by reduced protective microbes and enriched proinflammatory microbes. Ileal transcriptome profiles showed reduced transcripts for genes that control oxidative phosphorylation in CD patients with abnormal Paneth cells. These transcriptional changes in turn were correlated with specific microbiome alterations. In non-IBD patients, a subset contained abnormal Paneth cells. However, this subset was not associated with alterations in the microbiome or host transcriptome. CONCLUSION Paneth cell abnormalities in human subjects are associated with mucosal dysbiosis in the context of CD, and these changes are associated with alterations in oxidative phosphorylation, potentially in a feedback loop. FUNDING The research was funded by Helmsley Charitable Trust (to T.S. Stappenbeck, R.J. Xavier, and D.P.B. McGovern), Crohn's and Colitis Foundation of America (to N.H. Salzman, T.S. Stappenbeck, R.J. Xavier, and C. Huttenhower), and Doris Duke Charitable Foundation grant 2014103 (to T.C. Liu).
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Affiliation(s)
- Ta-Chiang Liu
- Department of Pathology and Immunology, Washington University, Saint Louis, Missouri, USA
| | - Bhaskar Gurram
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Megan T Baldridge
- Department of Pathology and Immunology, Washington University, Saint Louis, Missouri, USA
| | - Richard Head
- Genome Technology Access Center, Washington University, Saint Louis, Missouri, USA
| | - Vy Lam
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Chengwei Luo
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Yumei Cao
- Department of Pediatrics, Division of Quantitative Health Services, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Division of Quantitative Health Services, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Hayward
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary L Holtz
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pavlos Bousounis
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joshua Noe
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Diana Lerner
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jose Cabrera
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vincent Biank
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Stephens
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Curtis Huttenhower
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dermot Pb McGovern
- The F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ramnik J Xavier
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thaddeus S Stappenbeck
- Department of Pathology and Immunology, Washington University, Saint Louis, Missouri, USA
| | - Nita H Salzman
- Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Lerner D, Dandoy C, Hirsch R, Laskin B, Davies SM, Jodele S. Pericardial effusion in pediatric SCT recipients with thrombotic microangiopathy. Bone Marrow Transplant 2014; 49:862-3. [PMID: 24637900 DOI: 10.1038/bmt.2014.40] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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20
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Lerner D, Chuang LT, Moulton A, Rahaman J, Rodriguez-Dumont E, Dottino PR. The acceptance of “one to one” peer survivor counseling in patients with ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19602] [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: 11/20/2022] Open
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21
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Chuang LT, Romano S, Dottino PR, Rahaman J, Lerner D. Survival analysis of young patients with advanced-stage ovarian and primary peritoneal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15534] [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: 11/20/2022] Open
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22
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Nezhat F, Liu C, Lerner D, Chuang L. Fertility Sparing Robotic-Assisted Radical Trachelectomy and Bilateral Pelvic Lymphadenectomy in Early Stage Cervical Cancer. J Minim Invasive Gynecol 2008. [DOI: 10.1016/j.jmig.2008.09.566] [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: 11/27/2022]
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23
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Nogueira MC, Azevedo AM, Pereira SCM, Ferreira JL, Lerner D, Lobo AMG, Tavares RCBS, Tabak DG, Lorenzi N, Renault IZ, Bouzas LFS. Anti-tumor necrosis factor-a for the treatment of steroid-refractory acute graft-versus-host disease. ACTA ACUST UNITED AC 2007; 40:1623-9. [PMID: 17713663 DOI: 10.1590/s0100-879x2006005000145] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 05/09/2007] [Indexed: 11/22/2022]
Abstract
Allogeneic stem cell transplantation has been increasingly performed for a variety of hematologic diseases. Clinically significant acute graft-versus-host disease (GVHD) occurs in 9 to 50% of patients who receive allogeneic grafts, resulting in high morbidity and mortality. There is no standard therapy for patients with acute GVHD who do not respond to steroids. Studies have shown a possible benefit of anti-TNF-a (infliximab)for the treatment of acute GVHD. We report here on the outcomes of 10 recipients of related or unrelated stem cell transplants who received 10 mg/kg infliximab, iv, once weekly for a median of 3.5 doses (range: 1-6) for the treatment of severe acute GVHD and who were not responsive to standard therapy. All patients had acute GVHD grades II to IV (II = 2, III = 3, IV = 5). Overall, 9 patients responded and 1 patient had progressive disease. Among the responders, 3 had complete responses and 6 partial responses. All patients with cutaneous or gastrointestinal involvement responded, while only 2 of 6 patients with liver disease showed any response. None of the 10 patients had any kind of immediate toxicity. Four patients died, all of them with sepsis. Six patients are still alive after a median follow-up time of 544 days (92-600) after transplantation. Considering the severity of the cases and the bad prognosis associated with advanced acute GVHD, we find our results encouraging. Anti-TNF-a seems to be a useful agent for the treatment of acute GVHD.
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Affiliation(s)
- M C Nogueira
- Centro de Transplante de Medula óssea, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil.
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24
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Bouzas L, Moreira M, Tavares R, Lerner D, Azevedo A, Mattos M, Horn P, Collares M, Mellin S. 316: Characteristics of chronic graft-versus-host disease in Brazilian recipients of allogeneic stem cell transplants. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.321] [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: 11/28/2022]
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25
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Banwart SA, Thornton S, Rees H, Lerner D, Wilson R, Romero-Gonzalez M. In Situ Bioremediation by Natural Attenuation: from Lab to Field Scale. ACTA ACUST UNITED AC 2007. [DOI: 10.1063/1.2721282] [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: 11/14/2022]
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26
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Burke S, Heathwaite L, Quinn P, Merrett S, Whitehead P, Preedy N, Lerner D, Saul A. Strategic management of non-point source pollution from sewage sludge. Water Sci Technol 2003; 47:305-310. [PMID: 12793694] [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: 05/24/2023]
Abstract
In the UK, the recycling of sewage sludge to land is expected to double by 2006 but the security of this route is threatened by environmental concerns and health scares. Strategic investment is needed to ensure sustainable and secure sludge recycling outlets. At present, the security of this landbank for sludge recycling is determined by legislation relating to nutrient rather than potentially toxic elements (PTEs) applications to land--especially the environmental risk linked to soil phosphorus (P) saturation. We believe that not all land has an equal risk of contributing nutrients derived from applications to land to receiving waters. We are currently investigating whether it is possible to minimise nutrient loss by applying sludge to land outside Critical Source Areas (CSAs) regardless of soil P Index status. Research is underway to develop a predictive and spatially-sensitive, semi-distributed model of critical thresholds for sludge application that goes beyond traditional "end-of-pipe" or "edge-of-field" modelling, to include hydrological flow paths and delivery mechanisms to receiving waters from non-point sources at the catchment scale.
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Affiliation(s)
- S Burke
- Department of Geography, University of Sheffield, Winter Street, Sheffield S10 2TN, UK.
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27
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Steel PJ, LaHousse F, Lerner D, Marzin C. New ruthenium(II) complexes with pyridylpyrazole ligands. Photosubstitution and proton, carbon-13, and ruthenium-99 NMR structural studies. Inorg Chem 2002. [DOI: 10.1021/ic00152a014] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [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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28
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Gal M, Marzin C, Tarrago G, Zidane I, Hours T, Lerner D, Andrieux C, Gampp H, Saveant JM. New complexes of ruthenium(II) with a tetrapyrazolic macrocycle. Inorg Chem 2002. [DOI: 10.1021/ic00231a011] [Citation(s) in RCA: 3] [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: 11/29/2022]
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29
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Buschmann T, Lerner D, Lee CG, Ronai Z. The Mdm-2 amino terminus is required for Mdm2 binding and SUMO-1 conjugation by the E2 SUMO-1 conjugating enzyme Ubc9. J Biol Chem 2001; 276:40389-95. [PMID: 11384992 DOI: 10.1074/jbc.m103786200] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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: 11/06/2022] Open
Abstract
Covalent attachment of SUMO-1 to Mdm2 requires the activation of a heterodimeric Aos1-Uba2 enzyme (ubiquitin-activating enzyme (E1)) followed by the conjugation of Sumo-1 to Mdm2 by Ubc9, a protein with a strong sequence similarity to ubiquitin carrier proteins (E2s). Upon Sumo-1 conjugation, Mdm2 is protected from self-ubiquitination and elicits greater ubiquitin-protein isopeptide ligase (E3) activity toward p53, thereby increasing its oncogenic potential. Because of the biological implication of Mdm2 sumoylation, we mapped Ubc9 binding on Mdm2. Here we demonstrate that Ubc9 can associate with Mdm2 only if amino acids 40-59 within the N terminus of Mdm2 are present. Mdm2 from which amino acids 40-59 have been deleted can no longer be sumoylated. Furthermore, addition of a peptide that corresponds to amino acids 40-59 on Mdm2 to a sumoylation reaction efficiently inhibits Mdm2 sumoylation in vitro and in vivo. In UV-treated cells Mdm2 exhibits reduced association with Ubc9, which coincides with decreased Mdm2 sumoylation. Our findings regarding the association of Ubc9 with Mdm2, and the effect of UV-irradiation on Ubc9 binding, point to an additional level in the regulation of Mdm2 sumoylation under normal growth conditions as well as in response to stress conditions.
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Affiliation(s)
- T Buschmann
- Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, New York 10029, USA
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30
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Liao P, Georgakopoulos D, Kovacs A, Zheng M, Lerner D, Pu H, Saffitz J, Chien K, Xiao RP, Kass DA, Wang Y. The in vivo role of p38 MAP kinases in cardiac remodeling and restrictive cardiomyopathy. Proc Natl Acad Sci U S A 2001; 98:12283-8. [PMID: 11593045 PMCID: PMC59806 DOI: 10.1073/pnas.211086598] [Citation(s) in RCA: 260] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Stress-induced mitogen-activated protein kinase (MAP) p38 is activated in various forms of heart failure, yet its effects on the intact heart remain to be established. Targeted activation of p38 MAP kinase in ventricular myocytes was achieved in vivo by using a gene-switch transgenic strategy with activated mutants of upstream kinases MKK3bE and MKK6bE. Transgene expression resulted in significant induction of p38 kinase activity and premature death at 7-9 weeks. Both groups of transgenic hearts exhibited marked interstitial fibrosis and expression of fetal marker genes characteristic of cardiac failure, but no significant hypertrophy at the organ level. Echocardiographic and pressure-volume analyses revealed a similar extent of systolic contractile depression and restrictive diastolic abnormalities related to markedly increased passive chamber stiffness. However, MKK3bE-expressing hearts had increased end-systolic chamber volumes and a thinned ventricular wall, associated with heterogeneous myocyte atrophy, whereas MKK6bE hearts had reduced end-diastolic ventricular cavity size, a modest increase in myocyte size, and no significant myocyte atrophy. These data provide in vivo evidence for a negative inotropic and restrictive diastolic effect from p38 MAP kinase activation in ventricular myocytes and reveal specific roles of p38 pathway in the development of ventricular end-systolic remodeling.
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Affiliation(s)
- P Liao
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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31
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Boiron JM, Lerner D, Pigneux A, Fabères C, Bordessoule D, Turlure P, Cony-Makhoul P, Hau F, Dazey B, Agape P, Reiffers J, Marit G. Allogeneic transplantation for patients with advanced acute leukemia: a single center retrospective study of 92 patients. Leuk Lymphoma 2001; 41:285-96. [PMID: 11378541 DOI: 10.3109/10428190109057983] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Allogeneic transplantation is a well recognized treatment strategy of leukemia. However, its use in advanced leukemia patients is a subject of some debate especially when donors are not HLA-identical siblings because of the toxicity and cost of the procedure. We reviewed retrospectively the outcome of patients (pts) who received allogeneic transplantation for advanced acute leukemia in our center between 09/86 and 11/97. Thirty-six pts (study group) who lacked a matched sibling donor received partially matched related donor (n=14: PMRD group) or matched unrelated donor transplantation (n=22: MUD group). Fifteen pts had AML and 21 ALL. Seventeen pts (47%) were in CR>1, 13 pts (36%) had refractory disease and six pts (17.7%) were in untreated relapse. The outcome was compared to that of 56 patients (AML: 45.5 %, ALL: 55.5 %, CR>1: 49.9 %, refractory disease: 37.5 %, untreated relapse 19.6 %) who received allogeneic transplantation from a matched sibling donor (control group). Various conditioning regimens and GVHD prophylaxis were used. The actuarial incidence of grade II to IV acute GVHD was significantly higher in the study group (57%) than in the control group (34%) (p=0.047). The actuarial risk of relapse at three years was 21% +/- 22% in the study group versus 65% +/- 16% in the control group (p= 0.04). The actuarial probability of transplant-related mortality at 3 years is 64 +/- 16% for the study group and 25 +/- 11% for the control group (p=0.001). The leading cause of death in the study group was infection (30%) followed by acute GVHD and relapse. Relapse was the major cause of death in the control group (54%), followed by infection, interstitial pneumonia, veno-occlusive disease and GVHD. The OS and probability of leukemia-free survival at 3 years were 28 % +/- 15% (95% CI) and 27% +/- 15% (95% CI) in the study group. The overall survival and probability of LFS at 3 years were respectively 28 +/- 12% (95% CI) and 23 +/- 12% (95% CI) in the control group (p = 0.08 and p=0.11 respectively). In multivariate analysis, transplant-related mortality was higher in the study group (p=0.04) and lower if both donor and recipient were seronegative for CMV (p=0.007). OS was significantly higher for seronegative couples (p=0.0001), and when CR was achieved before BMT (p=0.0022). These results suggest that all efforts in this field should be directed on lowering the transplant related mortality for non geno-identical transplants and the relapse rate in geno-identical transplants.
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Affiliation(s)
- J M Boiron
- Service des Maladies du Sang, CHU Bordeaux, Hôpital Haut-Lévêque, Avenue de Magellan, 33604 Pessac.
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32
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Abstract
The baking expansion properties of sour cassava starch (Polvilho azedo) are attributable to photochemical starch degradation induced by heterolactic fermentation after sun-drying. This study investigated the effects of UV irradiation on the different structural levels of cassava starch as compared to those of corn starch and dextrins. Photosensitive compounds excited at 360 and 290 nm in cassava starch were photodegraded when starch was exposed to sunlight or 360 nm irradiation. UV irradiation depolymerized cassava and corn starches, inducing modifications due, at least in part, to a mechanism involving free radicals. Lactic acid was also photodegraded. Photodegradation induced by UV absorption could have been due to fluorescent chromophores found in starches and nonfluorescent chromophores present in glucosidic units.
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Affiliation(s)
- A C Bertolini
- Institut National de la Recherche Agronomique, Rue de la Géraudière, B.P. 71627, 44316 Nantes, France
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Abstract
OBJECTIVE The objective of this work was to develop a psychometrically sound questionnaire for measuring the on-the-job impact of chronic health problems and/or treatment ("work limitations"). RESEARCH DESIGN Three pilot studies (focus groups, cognitive interviews, and an alternate forms test) generated candidate items, dimensions, and response scales. Two field trials tested the psychometric performance of the questionnaire (studies 1 and 2). To test recall error, study 1 subjects were randomly assigned to 2 different questionnaire groups, a questionnaire with a 4-week reporting period completed once or a 2-week version completed twice. Responses were compared with data from concurrent work limitation diaries (the gold standard). To test construct validity, we compared questionnaire scores of patients with those of healthy job-matched control subjects. Study 2 was a cross-sectional mail survey testing scale reliability and construct validity. SUBJECTS The study subjects were employed individuals (18-64 years of age) from several chronic condition groups (study 1, n = 48; study 2, n = 121) and, in study 1, 17 healthy matched control subjects. MEASURES Study 1 included the assigned questionnaires and weekly diaries. Study 2 included the new questionnaire, SF-36, and work productivity loss items. RESULTS In study 1, questionnaire responses were consistent with diary data but were most highly correlated with the most recent week. Patients had significantly higher (worse) limitation scores than control subjects. In study 2, 4 scales from a 25-item questionnaire achieved Cronbach alphas of > or = 0.90 and correlated with health status and self-reported work productivity in the hypothesized manner (P < or = 0.05). CONCLUSIONS With 25 items, 4 dimensions (limitations handling time, physical, mental-interpersonal, and output demands), and a 2-week reporting period, the Work Limitations Questionnaire demonstrated high reliability and validity.
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Affiliation(s)
- D Lerner
- The Health Institute, Division of Clinical Care Research, New England Medical Center, Boston, Massachusetts 02111, USA.
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34
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de Lima M, Bonamino M, Vasconcelos Z, Colares M, Diamond H, Zalcberg I, Tavares R, Lerner D, Byington R, Bouzas L, da Matta J, Andrade C, Carvalho L, Pires V, Barone B, Maciel C, Tabak D. Prophylactic donor lymphocyte infusions after moderately ablative chemotherapy and stem cell transplantation for hematological malignancies: high remission rate among poor prognosis patients at the expense of graft-versus-host disease. Bone Marrow Transplant 2001; 27:73-8. [PMID: 11244440 DOI: 10.1038/sj.bmt.1702726] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [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: 11/09/2022]
Abstract
We investigated the use of 'prophylactic' donor lymphocyte infusions (DLI) containing 1 x 107 CD3+ cells, given at 30, 60 and 90 days post-allogeneic blood and marrow transplantation (BMT), following conditioning with fludarabine 30 mg/m(2)/4 days and melphalan 70 mg/m(2)/2 days. GVHD prophylaxis consisted of cyclosporin A (CsA) 2 mg/kg daily with early tapering by day 60. Our goals were the rapid achievement of chimerism and disease control, providing an immunological platform for DLIs to treat refractory patients with hematological malignancies. Twelve heavily pre-treated patients with life expectancy less than 6 months were studied; none were in remission. Diagnoses were AML (n = 4), MDS (n = 1), ALL (n = 3), CML (n = 3) and multiple myeloma (n = 1). Response rate was 75%. Three patients are alive at a median of 450 days (range, 450-540). Two patients are in remission of CML in blast crisis and AML for more than 14 months. Median survival is 116 days (range, 25-648). Six patients received 12 DLIs; three patients developed acute GVHD after the first infusion and were excluded from further DLIs, but no GVHD occurred among patients receiving subsequent DLIs. One patient with CML in blast crisis went into CR after the first DLI. The overall incidence of acute GVHD was 70%. Primary causes of death were infections (n = 3), acute GVHD (n = 3), chronic GVHD (n = 1) and disease relapse (n = 2). We observed high response and chimerism rates at the expense of an excessive incidence of GVHD. DLI given at day +30 post BMT caused GVHD in 50% of the patients, and its role in this setting remains unclear.
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Affiliation(s)
- M de Lima
- Bone Marrow Transplantation Unit, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
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Affiliation(s)
- B C Amick
- School of Public Health, University of Texas-Houston Health Science Center, Houston, Texas 77225, USA.
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36
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Abstract
In this paper, we examine the non-linearity of mechano-electric transduction in the cochlea by computing the instantaneous frequency (IF) of the cochlear microphonic (CM) in response to sinusoidal stimuli. In contrast to a linear system which yields a constant IF when driven with a sinusoid, the IF of the CM varied during one period of oscillation. This variation was not symmetric, but differed for positive and negative slopes of the CM. Administration of tetrodotoxin to eliminate neural activity indicated that the variation of the IF was not due to neural contamination. Moreover, comparing the IF of the stimulus to that of the CM indicated that the IF was not due to non-linearity in the acoustic signal. Signal frequency, signal level and acoustic trauma altered the IF. A cochlear model of the CM was developed to determine the influence of the saturation of hair-cell receptor currents and vector summation on the IF. Results indicated that these factors could not fully account for the variation in the IF. We conclude that the variation in IF within one period of cochlear partition vibration indicates that the mechanical and/or electrical oscillations which produce the CM differ from those of a linear system.
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Affiliation(s)
- M E Chertoff
- Department of Hearing and Speech, Kansas University Medical Center, Kansas City, KS 66160, USA.
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37
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Karras JG, McGraw K, McKay RA, Cooper SR, Lerner D, Lu T, Walker C, Dean NM, Monia BP. Inhibition of antigen-induced eosinophilia and late phase airway hyperresponsiveness by an IL-5 antisense oligonucleotide in mouse models of asthma. J Immunol 2000; 164:5409-15. [PMID: 10799906 DOI: 10.4049/jimmunol.164.10.5409] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic airway eosinophilia is associated with allergic asthma and is mediated in part by secretion of IL-5 from allergen-specific Th2 lymphocytes. IL-5 is a known maturation and antiapoptotic factor for eosinophils and stimulates release of nascent eosinophils from bone marrow into the peripheral circulation. An antisense oligonucleotide found to specifically inhibit IL-5 expression in vitro was observed to significantly reduce experimentally induced eosinophilia in vivo, in both the murine OVA lung challenge and allergic peritonitis models. Intravenous administration resulted in sequence-dependent inhibition of eosinophilia coincident with reduction of IL-5 protein levels, supporting an antisense mechanism of action. Potent suppression of lung eosinophilia was observed up to 17 days after cessation of oligonucleotide dosing, indicating achievement of prolonged protection with this strategy. Furthermore, sequence-specific, antisense oligonucleotide-mediated inhibition of Ag-mediated late phase airway hyperresponsiveness was also observed. These data underscore the potential utility of an antisense approach targeting IL-5 for the treatment of asthma and eosinophilic diseases.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Animals
- Antigens/administration & dosage
- Asthma/immunology
- Bronchial Hyperreactivity/immunology
- Bronchial Hyperreactivity/prevention & control
- Disease Models, Animal
- Eosinophilia/immunology
- Eosinophilia/prevention & control
- Gene Expression Regulation/immunology
- Injections, Intraperitoneal
- Injections, Intravenous
- Interleukin-5/antagonists & inhibitors
- Interleukin-5/biosynthesis
- Interleukin-5/genetics
- Male
- Mice
- Mice, Inbred BALB C
- Oligonucleotides, Antisense/administration & dosage
- Oligonucleotides, Antisense/pharmacology
- Oligonucleotides, Antisense/therapeutic use
- Ovalbumin/administration & dosage
- Ovalbumin/immunology
- RNA, Messenger/antagonists & inhibitors
- RNA, Messenger/biosynthesis
- Time Factors
- Tumor Cells, Cultured
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Affiliation(s)
- J G Karras
- Departments of Molecular and Cellular Pharmacology and Pharmacology, Isis Pharmaceuticals, Carlsbad, CA 92008, USA.
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Lai YC, Lerner D, Williams K, Grebogi C. Unstable dimension variability in coupled chaotic systems. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1999; 60:5445-54. [PMID: 11970417 DOI: 10.1103/physreve.60.5445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/1999] [Indexed: 04/18/2023]
Abstract
Systems of coupled chaotic maps and flows arise in many situations of physical and biological interest. The aim of this paper is to analyze and to present numerical evidence for a common type of nonhyperbolic behavior in these systems: unstable dimension variability. We show that unstable periodic orbits embedded in the dynamical invariant set of such a system can typically have different numbers of unstable directions. The consequence of this may be severe: the system cannot be modeled deterministically in the sense that no trajectory of the model can be realized by the natural chaotic system that the model is supposed to describe and quantify. We argue that unstable dimension variability can arise for small values of the coupling parameter. Severe modeling difficulties, nonetheless, occur only for reasonable coupling when the unstable dimension variability is appreciable. We speculate about the possible physical consequences in this case.
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Affiliation(s)
- Y C Lai
- Department of Mathematics, University of Kansas, Lawrence, Kansas 66045, USA
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39
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40
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Abstract
Migraine symptoms and therapy side effects cause significant functional disability that can result in work and productivity losses. Effective, well-tolerated migraine therapy with rapid onset of relief could decrease work and productivity losses. The Migraine Work and Productivity Loss Questionnaire (MWPLQ) evaluates the impact of migraine and migraine therapy on paid work. Data from a randomized, open-label extension study were collected over 3 months. Migraineurs were randomized to either rizatriptan (5HT1B/1D receptor agonist) or their usual migraine therapy. Data were analyzed from 164 patients who experienced at least one work-related migraine. Internal consistency (Cronbach's alpha) for the work difficulty domains ranged from 0.80 to 0.95. Work loss and work difficulty were moderately correlated (r = 0.39-0.58) with migraine severity and functional ability. Differences were found favoring rizatriptan for absenteeism (1.3 vs 2.4 h), effectiveness at work (62% vs 49%), and difficulty with work-related tasks (p < 0.01). The MWPLQ demonstrated favorable measurement characteristics in this study and could be an important research tool for future evaluations of migraine-related work disability.
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Affiliation(s)
- G M Davies
- Merck Research Laboratories, West Point, PA 19486, USA.
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41
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Sterling J, Veinberg A, Lerner D, Goldenberg W, Levy R, Youdim M, Finberg J. (R)(+)-N-propargyl-1-aminoindan (rasagiline) and derivatives: highly selective and potent inhibitors of monoamine oxidase B. J Neural Transm Suppl 1998; 52:301-5. [PMID: 9564630 DOI: 10.1007/978-3-7091-6499-0_30] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
(+)-N-Propargyl-1-aminoindan (rasagiline) and a series of derivatives have been synthesized and screened for monoamine oxidase inhibitory activity. Rasagiline and several analogues were found be highly selective and potent inhibitors of the B form of the enzyme in contrast to the levorotatory enantiomer which was not active. The results indicate that rasagiline has potential for the treatment of Parkinson's Disease. This compound is currently under development for that indication.
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Affiliation(s)
- J Sterling
- Teva Pharmaceutical Industries, Jerusalem, Israel
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42
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Amick BC, Kawachi I, Coakley EH, Lerner D, Levine S, Colditz GA. Relationship of job strain and iso-strain to health status in a cohort of women in the United States. Scand J Work Environ Health 1998; 24:54-61. [PMID: 9562401 DOI: 10.5271/sjweh.278] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study examined the relationships of job strain and iso-strain psychosocial work-environment exposures to health status in a cohort of working women in the United States. METHODS In a cross-sectional survey, 33689 women responded to the Karasek job content and the MOS SF-36 health status questionnaires. The psychosocial work-environment exposures were characterized using the job strain and iso-strain frameworks. Health status was assessed with the following 6 scales: physical functioning, vitality, freedom from pain, mental health, role limitations due to physical health, and role limitations due to emotional health. RESULTS When compared with active work, high-strain work (high job demands and low job control) was associated with lower vitality, mental health, higher pain, and increased risks of both physical and emotional role limitations. Iso-strain work (high strain and low work-related social support) increased the risks further. Job insecurity was also associated with lower health status. CONCLUSIONS The analyses supported the hypothesis that the psychosocial work environment is an important determinant of health status among working women. The findings suggest that incorporating social conditions at work into the measurement of psychosocial work-environment exposure improves the identification of high-risk work arrangements.
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Affiliation(s)
- B C Amick
- The Health Institute, New England Medical Center, Boston, Massachusetts 02111, United States.
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43
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Kim KK, Yokota H, Santoso S, Lerner D, Kim R, Kim SH. Purification, crystallization, and preliminary X-ray crystallographic data analysis of small heat shock protein homolog from Methanococcus jannaschii, a hyperthermophile. J Struct Biol 1998; 121:76-80. [PMID: 9573624 DOI: 10.1006/jsbi.1998.3969] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [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
A gene coding for a small heat shock protein homolog from the hyperthermophilic methanogenic Archaeon Methanococcus jannaschii was cloned. This gene was overexpressed in Escherichia coli harboring rare codon tRNAs and its protein purified and crystallized. Crystals displayed the space group R3 with unit cell dimensions a = b = 171.46 A and c = 102.13 A in a hexagonal axis setting. These crystals grew in one week and diffracted to 3.2 A resolution. The presence of eight molecules in the asymmetric unit gives a Vm value of 2.2 A3/Da and a solvent content of 44% by volume. The 24-molecule complex is generated from a subunit by a combination of crystallographic threefold symmetry and three types of noncrystallographic symmetries (a two-, a three-, and a fourfold).
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Affiliation(s)
- K K Kim
- Structural Biology Department of Lawrence Berkeley National Laboratory, University of California 94720, USA
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44
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Abstract
A new method for studying leakage of root fillings using the bacterium Pseudomonas fluorescens ATCC 13525 is described. The presence of the microorganism is detected by fluorimetry and can thus be used to measure the depth of penetration from the root apex toward the crown of the tooth. This system, applied to a number of methods of root canal filling, showed that procedures involving compaction of the gutta-percha gave a more effective seal than the use of a paste sealer with uncondensed gutta-percha. There was no statistically significant difference between the leakage results from the lateral, vertical, and thermomechanical condensed techniques.
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45
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Lerner D, Taylor F. Family physicians and first-trimester abortion: a survey of residency programs in southern California. Fam Med 1994; 26:157-62. [PMID: 8026660] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Since abortion has become a focus of increased public attention, it is important to assess family physicians' attitudes and scope of training regarding this outpatient procedure. METHODS Residents and faculty at eight southern California family practice residency programs were surveyed about their views on first-trimester abortion, and about their interest in training to perform the procedure. RESULTS While 62.5% of respondents believed abortion to be an appropriate procedure for family physicians to perform, only 19.5% had performed an abortion during the past year. Attitudes about situations in which abortion should be available to women were not associated with age, gender, or ethnicity. Religion of the respondents, however, was significantly associated with attitudes toward abortion. Of respondents without personal objections to the procedure, those who perceived the performance of abortion as appropriate for family physicians were significantly more likely to be interested in further training (48.2%) than those who did not perceive it as appropriate (18.2%, P = .0147). This perception of appropriateness was affected by whether or not a respondent had been offered training; those who had been offered training in abortion were 8.5 times more likely to believe it to be an appropriate procedure for family physicians to perform (P = .0001). CONCLUSION If the number of family physicians providing abortions is to be increased, residency programs must offer abortion training as a more fully recognized part of the family medicine curriculum.
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Affiliation(s)
- D Lerner
- UCLA Center for Health Sciences, Division of Family Medicine
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46
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Abstract
A 64-year-old woman is reported with Stage I (Rai) chronic lymphocytic leukaemia (CLL), in whom hypercalcemia developed when an increased proportion of prolymphocytic cells characterized a transformation of CLL in prolymphocytoid leukaemia (CLL/PL). Although hypercalcemia is more frequently found in T-cell leukaemia associated with human T lymphotropic lymphocyte type I, scattered reports indicate that patients with B-CLL can also be affected with this metabolic disturbance. The case described here, progressed with an indolent course of CLL for 26 months, when she was admitted with a very aggressive disease characterized by a high WBC count, splenomegaly and hypercalcemia. Despite an effort to achieve a clinical remission, she failed treatment and death was attributed to unresponsive hypercalcemia. The mechanism of hypercalcemia in such cases is unclear as no parathyroid adenoma or second malignant tumor was found ante mortem. This electrolytic disturbance would appear to be a direct consequence of the transforming leukaemia and a possible mechanism involving a secreted humoral factor that could lead to altered calcium metabolism.
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MESH Headings
- Antigens, CD/blood
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow/pathology
- Chlorambucil/therapeutic use
- Cyclophosphamide/administration & dosage
- Female
- Humans
- Hypercalcemia/blood
- Hypercalcemia/complications
- Hypercalcemia/pathology
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Prolymphocytic/blood
- Leukemia, Prolymphocytic/drug therapy
- Leukemia, Prolymphocytic/immunology
- Leukemia, Prolymphocytic/pathology
- Middle Aged
- Prednisone/administration & dosage
- Prednisone/therapeutic use
- Vincristine/administration & dosage
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Affiliation(s)
- D Lerner
- Department of Clinical Haematology of Instituto Nacional de Cancer, Rio de Janeiro, Brazil
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47
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Lerner D. N-STAT recruitment up as nurses volunteer for national grassroots network. Am Nurse 1993; 25:8. [PMID: 8285408] [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: 05/22/2023]
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48
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Lerner D. AAN forms grassroots network to mobilize nurses nationally. Am Nurse 1993; 25:3. [PMID: 8250423] [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: 05/22/2023]
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Abstract
The pediatric cardiovascular surgery patient has many needs, based not only on the complexity of the surgical procedure, but also on anatomic, physiologic, and emotional differences. These differences have implications for nursing care in the postoperative period. This article focuses on the special needs of a child who required correction of a congenital heart defect. The specialized knowledge required by the pediatric critical care nurse to make accurate assessments of the child's status and to intervene appropriately are emphasized. Issues surrounding the care of the family of the child who experiences cardiac surgery are highlighted.
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50
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Bitterman WA, Farhadian H, Abu Samra C, Lerner D, Amoun H, Krapf D, Makov UE. Environmental and nutritional factors significantly associated with cancer of the urinary tract among different ethnic groups. Urol Clin North Am 1991; 18:501-8. [PMID: 1877112] [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: 12/29/2022]
Abstract
A high incidence rate of urinary tract cancer in the Acre District among the Jewish population compared with the non-Jewish population has been studied. The dietary and environmental factors identified and the possible mechanisms of the protective effect that may be conferred by fluid intake, olives and olive oil, cumin, and pepper (chili pepper and pepper) are discussed.
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Affiliation(s)
- W A Bitterman
- Department of Urology, Western Galilee Regional Hospital, Nahariya, Israel
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