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Rosenfeld E, De León DD. Bridging the gaps: recent advances in diagnosis, care, and outcomes in congenital hyperinsulinism. Curr Opin Pediatr 2023; 35:486-493. [PMID: 36974442 PMCID: PMC10330427 DOI: 10.1097/mop.0000000000001243] [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] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW To highlight advances in congenital hyperinsulinism (HI), including newly described molecular mechanisms of disease, novel therapeutic interventions, and improved understanding of long-term outcomes. RECENT FINDINGS Important advances have been made elucidating the molecular mechanisms responsible for HI. Non-coding variants in HK1 have been found to cause aberrant hexokinase expression. Inactivating mutations in SLC25A36 have been identified in children with features of the hyperinsulinism hyperammonemia syndrome. Low-level mosaic mutations in known HI genes have been detected in cases of 'genetic testing negative' HI. Identification and localization of focal HI lesions remains a priority, since focal HI can be cured with surgery. Use of 68 Ga-NODAGA-exendin-4 PET has been proposed to localize focal lesions. Additional studies are needed before this technique replaces 18 F-DOPA PET as standard of care. Treatment options for children with diffuse HI remain limited. The long-acting somatostatin analog, lanreotide, was shown to significantly improve glycemic control in a large series of children with HI. New therapies are under development, with promising preliminary results. Long-term quality of life and neurodevelopmental outcomes remain suboptimal. SUMMARY Advanced genetic and epigenomic analytic techniques have uncovered novel molecular mechanisms of HI. Development of new drugs holds promise to improve long-term outcomes for individuals with HI.
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Affiliation(s)
- Elizabeth Rosenfeld
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Diva D. De León
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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2
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Holmlund TB, Cohen AS, Cheng J, Foltz PW, Bernstein J, Rosenfeld E, Laeng B, Elvevåg B. Using Automated Speech Processing for Repeated Measurements in a Clinical Setting of the Behavioral Variability in the Stroop Task. Brain Sci 2023; 13:442. [PMID: 36979252 PMCID: PMC10046258 DOI: 10.3390/brainsci13030442] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
The Stroop interference task is indispensable to current neuropsychological practice. Despite this, it is limited in its potential for repeated administration, its sensitivity and its demands on professionals and their clients. We evaluated a digital Stroop deployed using a smart device. Spoken responses were timed using automated speech recognition. Participants included adult nonpatients (N = 113; k = 5 sessions over 5 days) and patients with psychiatric diagnoses (N = 85; k = 3-4 sessions per week over 4 weeks). Traditional interference (difference in response time between color incongruent words vs. color neutral words; M = 0.121 s) and facilitation (neutral vs. color congruent words; M = 0.085 s) effects were robust and temporally stable over testing sessions (ICCs 0.50-0.86). The performance showed little relation to clinical symptoms for a two-week window for either nonpatients or patients but was related to self-reported concentration at the time of testing for both groups. Performance was also related to treatment outcomes in patients. The duration of response word utterances was longer in patients than in nonpatients. Measures of intra-individual variability showed promise for understanding clinical state and treatment outcome but were less temporally stable than measures based solely on average response time latency. This framework of remote assessment using speech processing technology enables the fine-grained longitudinal charting of cognition and verbal behavior. However, at present, there is a problematic lower limit to the absolute size of the effects that can be examined when using voice in such a brief 'out-of-the-laboratory condition' given the temporal resolution of the speech-to-text detection system (in this case, 10 ms). This resolution will limit the parsing of meaningful effect sizes.
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Affiliation(s)
- Terje B. Holmlund
- Department of Clinical Medicine, University of Tromsø—The Arctic University of Norway, 9037 Tromsø, Norway
| | - Alex S. Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Jian Cheng
- Analytic Measures Inc., Palo Alto, CA 94301, USA
| | - Peter W. Foltz
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO 80309, USA
| | | | | | - Bruno Laeng
- Department of Psychology, University of Oslo, 0315 Oslo, Norway
| | - Brita Elvevåg
- Department of Clinical Medicine, University of Tromsø—The Arctic University of Norway, 9037 Tromsø, Norway
- Norwegian Centre for eHealth Research, University Hospital of North Norway, 9038 Tromsø, Norway
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Rosenfeld E, Alzahrani O, De León DD. Undiagnosed hypoglycaemia disorders in children detected when hypoglycaemia occurs in the setting of illness: a retrospective study. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001842. [PMID: 36759017 PMCID: PMC9923327 DOI: 10.1136/bmjpo-2022-001842] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE Whether hypoglycaemia incidentally detected during intercurrent illness in children requires an endocrine workup remains controversial. This study aimed to determine the yield of conducting a diagnostic evaluation in this setting and to compare clinical and biochemical features between patients ultimately diagnosed with a hypoglycaemic disorder and those who were not. DESIGN Single-center, retrospective review of children referred to endocrinology between January 2013 and December 2018 for evaluation of hypoglycaemia (defined as plasma glucose<3.9 mmol/L (<70 mg/dL)) in the setting of acute illness. RESULTS 145 patients met eligibility criteria. A hypoglycaemia disorder was identified in 12 patients (8% of the cohort, 17% of those who underwent a diagnostic fast). There were no cases in which diagnosis was established in the absence of a diagnostic fast. Characteristics associated with identifying an underlying disorder included younger age (1.03 years (IQR: 0.05-1.54) vs 2.18 years [IQR: 1.29-3.99], p<0.001), higher bicarbonate level (22±5.5 mmol/L vs 16±3.6 mmol/L, p<0.001), lower frequency of elevated plasma or urine ketones (25% vs 92%, p=0.004) and lower frequency of other documented medical problems (17% vs 50%, p=0.03). CONCLUSIONS The yield of diagnostic evaluation among children with incidental detection of hypoglycaemia in the setting of illness is not insignificant. We thus recommend that all children with hypoglycaemia in the setting of illness undergo guided diagnostic evaluation. Younger age and absence of ketosis and acidosis at presentation may serve as useful predictors for establishing a diagnosis. Future studies are needed to confirm these findings.
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Affiliation(s)
- Elizabeth Rosenfeld
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ohoud Alzahrani
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Diva D De León
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA .,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Kurman N, Mizrachi A, Rosenfeld E, Ben-Hur R, Feliciani G, Bellia S, Sarnelli A, Keisari Y, Kelson I, Den R, Popovtzer A. Long-Term Follow-Up Evaluation of Efficacy in Alpha-Emitting Radiation Therapy on Recurrent and Locally Advanced Squamous Cell Carcinomas in Multi-Center Clinical Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2168] [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: 10/31/2022]
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Rosenfeld E, Nanga RPR, Lucas A, Revell AY, Thomas A, Thomas NH, Roalf DR, Shinohara RT, Reddy R, Davis KA, De León DD. Correction: Characterizing the neurological phenotype of the hyperinsulinism hyperammonemia syndrome. Orphanet J Rare Dis 2022; 17:315. [PMID: 35982497 PMCID: PMC9386909 DOI: 10.1186/s13023-022-02466-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Elizabeth Rosenfeld
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Philadelphia, PA, 19140, USA. .,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Ravi Prakash Reddy Nanga
- Center for Advanced Metabolic Imaging in Precision Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Alfredo Lucas
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Y Revell
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison Thomas
- Behavioral Neuroscience Core, Center for Human Phenomic Science, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nina H Thomas
- Behavioral Neuroscience Core, Center for Human Phenomic Science, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ravinder Reddy
- Center for Advanced Metabolic Imaging in Precision Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Diva D De León
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Philadelphia, PA, 19140, USA.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Boodhansingh KE, Rosenfeld E, Lord K, Adzick NS, Bhatti T, Ganguly A, De Leon DD, Stanley CA. Mosaic GLUD1 Mutations Associated with Hyperinsulinism Hyperammonemia Syndrome. Horm Res Paediatr 2022; 95:492-498. [PMID: 35952631 PMCID: PMC9671865 DOI: 10.1159/000526203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The hyperinsulinemia-hyperammonemia syndrome (HIHA) is the second most common cause of congenital hyperinsulinism and is caused by activating heterozygous missense mutations in GLUD1. In the majority of HIHA cases, the GLUD1 mutation is found to be de novo. We have identified 3 patients in whom clinical evaluation was suggestive of HIHA but with negative mutation analysis in peripheral blood DNA for GLUD1 as well as other known HI genes. METHODS We performed next-generation sequencing (NGS) on peripheral blood DNA from two children with clinical features of HIHA in order to look for mosaic mutations in GLUD1. Pancreas tissue was also available in one of these cases for NGS. In addition, NGS was performed on peripheral blood DNA from a woman with a history of HI in infancy whose child had HIHA due to a presumed de novo GLUD1 mutation. RESULTS Mosaic GLUD1 mutations were identified in these 3 cases at percent mosaicism ranging from 2.7% to 10.4% in peripheral blood. In one case with pancreas tissue available, the mosaic GLUD1 mutation was present at 17.9% and 28.9% in different sections of the pancreas. Two unique GLUD1 mutations were identified in these cases, both of which have been previously reported (c.1493c>t/p.Ser445Leu and c.820c>t/p.Arg221Cys). CONCLUSION The results suggest that low-level mosaic mutations in known HI genes may be the underlying molecular mechanism in some children with HI who have negative genetic testing in peripheral blood DNA.
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Affiliation(s)
- Kara E. Boodhansingh
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth Rosenfeld
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine Lord
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - N. Scott Adzick
- Department of Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tricia Bhatti
- Department of Pathology, The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arupa Ganguly
- Department of Genetics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diva D. De Leon
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles A. Stanley
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Patel M, Schultz K, Rosenfeld E. The earliest known reported occurrence of dentigerous cyst in a six-month-old child. Int J Oral Maxillofac Surg 2022; 51:1535-1537. [PMID: 35871878 DOI: 10.1016/j.ijom.2022.06.014] [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: 02/26/2022] [Revised: 05/23/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022]
Abstract
The earliest reported case of the occurrence of a dentigerous cyst is described; the cyst surrounded an unerupted permanent tooth bud in a 6-month-old infant. Most commonly these lesions present between the second and third decades of life. They rarely occur before 10 years of age and have not been documented prior to 1 year of age. In the case reported here, the treatment instituted was extraction of the adjacent deciduous tooth and enucleation of the cyst along with the permanent molar tooth bud. Clinicians should be aware of the potential for this lesion to occur across a wide range of ages and the importance of prompt diagnosis and treatment to prevent complications and reduce morbidity.
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Affiliation(s)
- M Patel
- Department of Dental Medicine, Division of Oral and Maxillofacial Surgery, Northwell Health Long Island Jewish Medical Center, Queens, NY, USA.
| | - K Schultz
- Department of Dental Medicine, Division of Oral Pathology, Northwell Health Long Island Jewish Medical Center, Queens, NY, USA
| | - E Rosenfeld
- Department of Dental Medicine, Division of Oral and Maxillofacial Surgery, Northwell Health Long Island Jewish Medical Center, Queens, NY, USA
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Rosenfeld E, Nanga RPR, Lucas A, Revell AY, Thomas A, Thomas NH, Roalf DR, Shinohara RT, Reddy R, Davis KA, De León DD. Characterizing the neurological phenotype of the hyperinsulinism hyperammonemia syndrome. Orphanet J Rare Dis 2022; 17:248. [PMID: 35752848 PMCID: PMC9233810 DOI: 10.1186/s13023-022-02398-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyperinsulinism hyperammonemia (HI/HA) syndrome is caused by activating mutations in GLUD1, encoding glutamate dehydrogenase (GDH). Atypical absence seizures and neuropsychological disorders occur at high rates in this form of hyperinsulinism. Dysregulated central nervous system (CNS) glutamate balance, due to GDH overactivity in the brain, has been hypothesized to play a role. This study aimed to describe the neurologic phenotype in HI/HA syndrome and investigate CNS glutamate levels using glutamate weighted chemical exchange saturation transfer magnetic resonance imaging (GluCEST MRI). In this cross-sectional study, 12 subjects with HI/HA syndrome had plasma ammonia measurement, self- or parent-completed neurocognitive assessments, electroencephalogram (EEG), and GluCEST MRI at 7 T performed. GluCEST MRI measures were compared to a historic reference population of 10 healthy adults. RESULTS Subjects were five males and seven females with median age of 25.5 years. Seventy-five percent of subjects reported a history of neurodevelopmental problems and 42% had neurocognitive assessment scores outside the normal range. Fifty percent had interictal EEG findings of generalized, irregular spike and wave discharges. Higher variability in hippocampal GluCEST asymmetry (p = 0.002), and in peak hippocampal GluCEST values (p = 0.008), was observed in HI/HA subjects (n = 9 with interpretable MRI) compared to the healthy reference population (n = 10). CONCLUSIONS The high prevalence of abnormal neurocognitive assessment scores and interictal EEG findings observed highlights the importance of longitudinal neuropsychological assessment for individuals with HI/HA syndrome. Our findings demonstrate the potential application of GluCEST to investigate persistent knowledge gaps in the mechanisms underlying the unique neurophenotype of this disorder.
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Affiliation(s)
- Elizabeth Rosenfeld
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Philadelphia, PA, 19140, USA. .,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Ravi Prakash Reddy Nanga
- Center for Advanced Metabolic Imaging in Precision Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Alfredo Lucas
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Y Revell
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison Thomas
- Behavioral Neuroscience Core, Center for Human Phenomic Science, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nina H Thomas
- Behavioral Neuroscience Core, Center for Human Phenomic Science, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Russel T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ravinder Reddy
- Center for Advanced Metabolic Imaging in Precision Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Diva D De León
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Philadelphia, PA, 19140, USA.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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9
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Rosenfeld E, Getz KD, Miller TP, Seif AE, Fisher BT, Burrows E, Ramos MJ, De León DD, Aplenc R, Morales KH, Guevara JP. Incidence and risk factors for hypoglycemia during maintenance chemotherapy in pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2022; 69:e29467. [PMID: 34811879 PMCID: PMC9038623 DOI: 10.1002/pbc.29467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/10/2021] [Revised: 10/09/2021] [Accepted: 11/01/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fasting hypoglycemia is a recognized occurrence among pediatric patients with acute lymphoblastic leukemia (ALL) during maintenance therapy. Existing publications describing this finding are limited to small studies and case reports. Our objective was to determine the incidence of hypoglycemia during maintenance chemotherapy and to investigate the association of age, as well as other potential risk factors, with this outcome in pediatric patients with ALL. PROCEDURE This retrospective cohort study included individuals 1 to 21 years of age with ALL treated with antimetabolite-containing maintenance chemotherapy at a large children's hospital between January 2011 and December 2014. The primary endpoint was time to first documented episode of hypoglycemia during maintenance therapy, defined as single measurement of plasma glucose <60 mg/dL. Cox regression was used to evaluate the association with age and identify other potential risk factors. RESULTS We identified 126 eligible patients, of whom 63% were documented as White, non-Hispanic, 28% as non-White, non-Hispanic, and 9% as Hispanic. Twenty-eight children (22%) had documented hypoglycemia during maintenance therapy. Younger age at the start of maintenance and hepatotoxicity documented during chemotherapy prior to maintenance initiation were associated with hypoglycemia (adjusted HR age = 0.88; 95% CI, 0.78-0.99; adjusted HR prior hepatotoxicity = 3.50; 95% CI, 1.47-8.36). CONCLUSIONS Nearly one quarter of children in our cohort had hypoglycemia documented during maintenance chemotherapy. Younger age at maintenance initiation and hepatotoxicity during chemotherapy prior to maintenance initiation emerged as risk factors. These findings highlight the importance of counseling about the risk of, and monitoring for, hypoglycemia, particularly in young children.
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Affiliation(s)
- Elizabeth Rosenfeld
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly D. Getz
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tamara P. Miller
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alix E. Seif
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian T. Fisher
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Evanette Burrows
- Center for Biomedical Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mark Jason Ramos
- Center for Biomedical Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Diva D. De León
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard Aplenc
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Knashawn H. Morales
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James P. Guevara
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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10
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Rosenfeld E, Mitteer L, Boodhansingh K, Becker SA, McKnight H, Boyajian L, Ackermann AM, Kalish JM, Bhatti TR, States LJ, Adzick NS, Lord K, De León DD. Case Report: Two Distinct Focal Congenital Hyperinsulinism Lesions Resulting From Separate Genetic Events. Front Pediatr 2021; 9:699129. [PMID: 34336745 PMCID: PMC8322518 DOI: 10.3389/fped.2021.699129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/22/2021] [Accepted: 06/18/2021] [Indexed: 01/06/2023] Open
Abstract
Focal hyperinsulinism (HI) comprises nearly 50% of all surgically treated HI cases and is cured if the focal lesion can be completely resected. Pre-operative localization of the lesion is thus critical. Few cases of hyperinsulinism with multiple focal lesions have been reported, and assessment of the molecular mechanisms driving this rare occurrence has been limited. We present two cases of multifocal HI, each resulting from two independent, pancreatic focal lesions. 18Fluoro-dihydroxyphenylalanine positron emission tomography/computed tomography detected both lesions preoperatively in one patient, whereas identification of the second lesion was an incidental finding during surgical exploration in the other. Complete resection of the focal lesions resulted in cure of the HI in both cases. In each patient, genetic testing of the individual focal lesions revealed different regions of loss of heterozygosity for the maternal 11p15 allele, confirming that each lesion arose from independent somatic events in the setting of a paternally inherited germline ABCC8 mutation. These cases highlight the importance of a multidisciplinary and personalized approach to the management of infants with HI.
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Affiliation(s)
- Elizabeth Rosenfeld
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Lauren Mitteer
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kara Boodhansingh
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Susan A Becker
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Heather McKnight
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Linda Boyajian
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Amanda M Ackermann
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer M Kalish
- Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Tricia R Bhatti
- Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Lisa J States
- Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - N Scott Adzick
- Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Katherine Lord
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Diva D De León
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Congenital Hyperinsulinism Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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11
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Rosenfeld E, Nanga RPR, Reddy R, Revell A, Roalf DR, Davis KA, De Leon DD. MON-110 Utilization of GluCEST, a Novel Neuroimaging Technique, to Characterize the Brain Phenotype in Hyperinsulinism/Hyperammonemia Syndrome. J Endocr Soc 2020. [PMCID: PMC7209661 DOI: 10.1210/jendso/bvaa046.594] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND: Hyperinsulinism/Hyperammonemia (HI/HA) syndrome is the second most common form of congenital hyperinsulinism. It is caused by gain-of-function mutations in glutamate dehydrogenase (GDH), a mitochondrial enzyme expressed in pancreatic β-cells, liver, kidney, and brain, and is responsible for metabolizing glutamate into α-ketoglutarate and ammonia. In addition to hyperinsulinemic hypoglycemia due to abnormal GDH activity in pancreatic β-cells, ~80% of patients have developmental delays, learning, or behavioral disorders and >60% have atypical absence seizures (Bahi-Buisson, 2008). These neurologic symptoms are not fully explained by hypoglycemia and are hypothesized to result from central nervous system (CNS) glutamate imbalance due to CNS GDH overactivity. Newer magnetic resonance imaging (MRI) techniques have allowed for sensitive estimation of CNS glutamate using Glutamate Chemical Exchange Saturation Transfer (GluCEST). We aimed to comprehensively characterize the biochemical and clinical neurologic phenotype of HI/HA leveraging GluCEST MRI.
Methods: Subjects with confirmed HI/HA diagnosis and without contraindication to MRI had electroencephalogram (EEG), serum ammonia, and the following validated neurodevelopmental assessments: ABAS-3, BRIEF, and ASEBA CBCL (if <18 years) or ASR (if >18 years) completed. GluCEST MRI axial hippocampal and midsagittal slices were acquired on a 7.0T Siemens scanner and reported as GluCEST % contrast. Healthy control GluCEST % contrast data were obtained from a separate study using the same neuroimaging protocol.
Results: 8 HI/HA subjects (4 female; mean age 28 years [range 16-56] years) participated to date. Median serum ammonia was 58 umol/L (IQR 39-89). 50% self-reported learning impairments and 37.5% self-reported prior ADHD diagnosis. Marked unilateral increase in hippocampal GluCEST % contrast was observed in 3/6 subjects (2 L>R; 1 R>L). Overall, median peak GluCEST % contrast level was significantly higher in HI/HA subjects than controls (10.3% [IQR 8.9-11.3] v. 8.0% [IQR 7.8-8.4], p=0.0013, n=6).
Conclusions: This is the first study to evaluate CNS glutamate via GluCEST in HI/HA. Hippocampal glutamate, measured by GluCEST % contrast, was significantly higher in HI/HA subjects than healthy controls. Laterality in hippocampal glutamate was observed in half of subjects. These findings are remarkable given the known role of abnormal glutamate signaling in the development of epilepsy and neurocognitive impairment. Next steps are to complete midsagittal GluCEST image processing, EEG and neurodevelopmental assessment interpretations to explore correlations between CNS phenotype and brain glutamate pattern. GluCEST holds promise for elucidating the pathophysiology of CNS manifestations in HI/HA syndrome.
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Affiliation(s)
| | - Ravi P R Nanga
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ravinder Reddy
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Andy Revell
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David R Roalf
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Diva D De Leon
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Gieseler J, Kabcenell A, Rosenfeld E, Schaefer JD, Safira A, Schuetz MJA, Gonzalez-Ballestero C, Rusconi CC, Romero-Isart O, Lukin MD. Single-Spin Magnetomechanics with Levitated Micromagnets. Phys Rev Lett 2020; 124:163604. [PMID: 32383959 DOI: 10.1103/physrevlett.124.163604] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
We demonstrate a new mechanical transduction platform for individual spin qubits. In our approach, single micromagnets are trapped using a type-II superconductor in proximity of spin qubits, enabling direct magnetic coupling between the two systems. Controlling the distance between the magnet and the superconductor during cooldown, we demonstrate three-dimensional trapping with quality factors around 1×10^{6} and kHz trapping frequencies. We further exploit the large magnetic moment to mass ratio of this mechanical oscillator to couple its motion to the spin degrees of freedom of an individual nitrogen vacancy center in diamond. Our approach provides a new path towards interfacing individual spin qubits with mechanical motion for testing quantum mechanics with mesoscopic objects, realization of quantum networks, and ultrasensitive metrology.
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Affiliation(s)
- J Gieseler
- Physics Department, Harvard University, Cambridge, Massachusetts 02138, USA
| | - A Kabcenell
- Physics Department, Harvard University, Cambridge, Massachusetts 02138, USA
| | - E Rosenfeld
- Physics Department, Harvard University, Cambridge, Massachusetts 02138, USA
| | - J D Schaefer
- Physics Department, Harvard University, Cambridge, Massachusetts 02138, USA
| | - A Safira
- Physics Department, Harvard University, Cambridge, Massachusetts 02138, USA
| | - M J A Schuetz
- Physics Department, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C Gonzalez-Ballestero
- Institute for Quantum Optics and Quantum Information of the Austrian Academy of sciences, A-6020 Innsbruck, Austria
- Institute for Theoretical Physics, University of Innsbruck, A-6020 Innsbruck, Austria
| | - C C Rusconi
- Max-Planck-Institut für Quantenoptik, Hans-Kopfermann-Strasse 1, 85748 Garching, Germany
| | - O Romero-Isart
- Institute for Quantum Optics and Quantum Information of the Austrian Academy of sciences, A-6020 Innsbruck, Austria
- Institute for Theoretical Physics, University of Innsbruck, A-6020 Innsbruck, Austria
| | - M D Lukin
- Physics Department, Harvard University, Cambridge, Massachusetts 02138, USA
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13
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Popovtzer A, Rosenfeld E, Mizrachi A, Bellia SR, Ben-Hur R, Feliciani G, Sarnelli A, Arazi L, Deutsch L, Kelson I, Keisari Y. Initial Safety and Tumor Control Results From a "First-in-Human" Multicenter Prospective Trial Evaluating a Novel Alpha-Emitting Radionuclide for the Treatment of Locally Advanced Recurrent Squamous Cell Carcinomas of the Skin and Head and Neck. Int J Radiat Oncol Biol Phys 2019; 106:571-578. [PMID: 31759075 DOI: 10.1016/j.ijrobp.2019.10.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/04/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Our purpose was to report the feasibility and safety of diffusing alpha-emitter radiation therapy (DaRT), which entails the interstitial implantation of a novel alpha-emitting brachytherapy source, for the treatment of locally advanced and recurrent squamous cancers of the skin and head and neck. METHODS AND MATERIALS This prospective first-in-human, multicenter clinical study evaluated 31 lesions in 28 patients. The primary objective was to determine the feasibility and safety of this approach, and the secondary objectives were to evaluate the initial tumor response and local progression-free survival. Eligibility criteria included all patients with biopsy-proven squamous cancers of the skin and head and neck with either primary tumors or recurrent/previously treated disease by either surgery or prior external beam radiation therapy; 13 of 31 lesions (42%) had received prior radiation therapy. Toxicity was evaluated according to the Common Terminology Criteria for Adverse Events version 4.03. Tumor response was assessed at 30 to 45 days at a follow-up visit using the Response Evaluation Criteria in Solid Tumors, version 1.1. Median follow-up time was 6.7 months. RESULTS Acute toxicity included mostly local pain and erythema at the implantation site followed by swelling and mild skin ulceration. For pain and grade 2 skin ulcerations, 90% of patients had resolution within 3 to 5 weeks. Complete response to the Ra-224 DaRT treatment was observed in 22 lesions (22/28; 78.6%); 6 lesions (6/28, 21.4%) manifested a partial response (>30% tumor reduction). Among the 22 lesions with a complete response, 5 (22%) developed a subsequent local relapse at the site of DaRT implantation at a median time of 4.9 months (range, 2.43-5.52 months). The 1-year local progression-free survival probability at the implanted site was 44% overall (confidence interval [CI], 20.3%-64.3%) and 60% (95% CI, 28.61%-81.35%) for complete responders. Overall survival rates at 12 months post-DaRT implantation were 75% (95% CI, 46.14%-89.99%) among all patients and 93% (95% CI, 59.08%-98.96%) among complete responders. CONCLUSIONS Alpha-emitter brachytherapy using DaRT achieved significant tumor responses without grade 3 or higher toxicities observed. Longer follow-up observations and larger studies are underway to validate these findings.
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Affiliation(s)
- A Popovtzer
- Rabin Medical Center Petah Tiqva, Petah Tiqva, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - E Rosenfeld
- Rabin Medical Center Petah Tiqva, Petah Tiqva, Israel
| | - A Mizrachi
- Rabin Medical Center Petah Tiqva, Petah Tiqva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - S R Bellia
- Instituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori, (IRST)-IRCCS, Meldola, Italy
| | - R Ben-Hur
- Rabin Medical Center Petah Tiqva, Petah Tiqva, Israel
| | - G Feliciani
- Instituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori, (IRST)-IRCCS, Meldola, Italy
| | - A Sarnelli
- Instituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori, (IRST)-IRCCS, Meldola, Italy
| | - L Arazi
- Ben-Gurion University of the Negev, Beersheba, Israel
| | - L Deutsch
- BioStats Statistical Consult, Merkez Renanim, Maccabim Israel
| | - I Kelson
- Tel Aviv University, Tel Aviv, Israel
| | - Y Keisari
- Tel Aviv University, Tel Aviv, Israel
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14
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Cohen AS, Fedechko T, Schwartz EK, Le TP, Foltz PW, Bernstein J, Cheng J, Rosenfeld E, Elvevåg B. Psychiatric Risk Assessment from the Clinician's Perspective: Lessons for the Future. Community Ment Health J 2019; 55:1165-1172. [PMID: 31154587 DOI: 10.1007/s10597-019-00411-x] [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: 04/10/2018] [Accepted: 05/13/2019] [Indexed: 01/30/2023]
Abstract
Accurate prediction of risk-states in Serious Mental Illnesses (SMIs) is critical for reducing their massive societal burden. Risk-state assessments are notably inaccurate. Recent innovations, including widely available and inexpensive mobile technologies for ambulatory "biobehavioral" data, can reshape risk assessment. To help understand and accelerate clinician involvement, we surveyed 90 multi-disciplinary clinicians serving SMI populations in various settings to evaluate how risk assessment is conducted and can improve. Clinicians reported considerable variability in conducting risk assessment, and few clinicians explicated their procedures beyond tying it to broader mental status examinations or interviews. Very few clinicians endorsed using currently-available standardized risk measures, and most reported low confidence in their utility. Clinicians also reported spending approximately half the time conducting individual risk assessments than optimally needed. When asked about improvement, virtually no clinicians acknowledged biobehavioral, objective technologies, or ambulatory recording. Overall, clinicians seemed unaware of meaningful ways to improve risk assessment.
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Affiliation(s)
- Alex S Cohen
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
| | - Taylor Fedechko
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Elana K Schwartz
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Thanh P Le
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Peter W Foltz
- Institute of Cognitive Science, University of Colorado, Boulder, USA
| | | | - Jian Cheng
- Analytic Measures Inc, Palo Alto, CA, USA
| | | | - Brita Elvevåg
- Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,The Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromsø, Norway
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15
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Popovtzer A, Keisari Y, Rosenfeld E, Kelson I, Mizrachy A, Ben-Hur R. Long Term Follow-up for the First Alpha-particle Based Radiotherapy (Alpha DaRT) for Squamous Cell Carcinoma in the Skin and Oral Cavity. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Rosenfeld E, Ganguly A, De Leon DD. Congenital hyperinsulinism disorders: Genetic and clinical characteristics. Am J Med Genet C Semin Med Genet 2019; 181:682-692. [PMID: 31414570 DOI: 10.1002/ajmg.c.31737] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/13/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022]
Abstract
Congenital hyperinsulinism (HI) is the most frequent cause of persistent hypoglycemia in infants and children. Delays in diagnosis and initiation of appropriate treatment contribute to a high risk of neurocognitive impairment. HI represents a heterogeneous group of disorders characterized by dysregulated insulin secretion by the pancreatic beta cells, which in utero, may result in somatic overgrowth. There are at least nine known monogenic forms of HI as well as several syndromic forms. Molecular diagnosis allows for prediction of responsiveness to medical treatment and likelihood of surgically-curable focal hyperinsulinism. Timely genetic mutation analysis has thus become standard of care. However, despite significant advances in our understanding of the molecular basis of this disorder, the number of patients without an identified genetic diagnosis remains high, suggesting that there are likely additional genetic loci that have yet to be discovered.
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Affiliation(s)
- Elizabeth Rosenfeld
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Arupa Ganguly
- Department of Genetics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diva D De Leon
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Holmlund TB, Foltz PW, Cohen AS, Johansen HD, Sigurdsen R, Fugelli P, Bergsager D, Cheng J, Bernstein J, Rosenfeld E, Elvevåg B. Moving psychological assessment out of the controlled laboratory setting: Practical challenges. Psychol Assess 2019; 31:292-303. [PMID: 30802115 DOI: 10.1037/pas0000647] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral assessment using smart devices affords novel methods, notably remote self-administration by the individuals themselves. However, this new approach requires navigating complex legal and technical terrain. Given the limited empirical data that currently exists, we provide and discuss anecdotes of the methodological, technical, legal, and cultural issues associated with an implementation in both U.S. and European settings of a mobile software application for regular psychological monitoring purposes. The tasks required participants to listen, watch, speak, and touch to interact with the smart device, thus assessing cognition, motor skill, and language. Four major findings merit mention: First, moving assessment out of the hands of a trained investigator necessitates excellent usability engineering, such that the tool is easily usable by the participant and the resulting data relevant to the investigator. Second, remote assessment requires that the data are transferred safely back to the investigator, and that risk of compromising participant confidentiality is minimized. Third, frequent data collection over long periods of time is associated with a possibility that participants may choose to withdraw consent for participation thus requiring data retraction. Fourth, data collection and analysis across international borders creates new challenges and new opportunities because of important cultural and language issues that may inform the underlying behavioral constructs of interest. In conclusion, the new technological frameworks provide unprecedented opportunities for remote self-administered behavioral assessments but will be most productive in multidisciplinary teams to ensure the highest level of user satisfaction and data quality, and to guarantee the highest level of data protection. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Peter W Foltz
- Institute of Cognitive Science, University of Colorado
| | - Alex S Cohen
- Department of Psychology, Louisiana State University
| | | | | | - Pål Fugelli
- University Center for Information Technology, University of Oslo
| | | | | | | | | | - Brita Elvevåg
- Department of Clinical Medicine, University of Tromsø
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18
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Rosenfeld E, Mizrachi A, Ben-Hur R, Keisari Y, Kelson I, Popovtzer A. Treatment of squamous cell carcinoma by alpha-radiation based brachytherapy (alpha dart), a new radiation concep. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.253] [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: 10/26/2022]
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19
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Rosenfeld E, Li C, De Leon-Crutchlow D. OR05-2 Targeted Inhibition of Glutamate Dehydrogenase by Alpha-Tocopherol: A Potential Novel Treatment for Hyperinsulinism Hyperammonemia Syndrome. J Endocr Soc 2019. [PMCID: PMC6555078 DOI: 10.1210/js.2019-or05-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Congenital hyperinsulinism is a rare genetic disorder that causes severe hypoglycemia and can lead to permanent brain damage if inadequately controlled. Gain of function mutations in glutamate dehydrogenase (GDH) result in hyperinsulinism hyperammonemia (HI/HA) syndrome, the second most common cause of congenital hyperinsulinism. Current therapies inhibit insulin secretion but do not target GDH overactivity directly and thus fail to treat the spectrum of clinical manifestations observed, which in addition to hyperinsulinism and hyperammonemia, include seizures and developmental delays. The neurological symptoms are profound and occur independent of the hypoglycemia. We investigated the efficacy of alpha-tocopherol as a targeted GDH inhibitor in vitro and in vivo models of HI/HA syndrome. Human embryonic kidney (HEK293T) cells were transduced with lentivirus to overexpress either wild-type GDH or H454Y GDH, a well-characterized disease-causing mutant. GDH enzyme kinetics were determined spectrophotometrically in cell homogenates perfused with escalating concentrations of alpha-tocopherol on a background of 10mM glutamine. To evaluate the inhibitory effect of alpha-tocopherol on GDH in vivo, wild-type (WT, n=10) and H454Y GDH transgenic (Tg, n=13) adult mice were treated with oral alpha-tocopherol (75 μg/g body weight/dose) or vehicle twice daily for 3 doses and then fasted for 6 hours. Nadir fasting plasma glucoses were measured as a clinical correlate of GDH activity and compared between alpha-tocopherol and vehicle-treated wild-type and transgenic mice, respectively. Alpha-tocopherol effectively inhibited activity of wild-type and H454Y mutant GDH in HEK293T cells with 50% inhibitory concentration (IC50) of 4.1 and 3.1 μM, respectively. In vivo, nadir fasting plasma glucose was significantly higher in alpha-tocopherol-treated versus vehicle-treated WT and Tg mice (WT: mean nadir plasma glucose 94.3 ± 9.6 mg/dl v. 80.1 ± 9.6 mg/dl, p=0.003; Tg: mean nadir plasma glucose 71.9± 11.3 mg/dl v. 57.2 ± 12.6 mg/dl, p=0.002). Alpha-tocopherol effectively inhibits GDH in vitro and ameliorates fasting hypoglycemia in vivo in a mouse model of HI/HA syndrome. Based upon these findings, alpha-tocopherol is a promising potential treatment for HI/HA syndrome. Our next step will be to study the safety and efficacy of oral alpha-tocopherol supplementation in human subjects with HI/HA syndrome.
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Affiliation(s)
| | - Changhong Li
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Diva De Leon-Crutchlow
- Div of Endo/Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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20
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Popovtzer A, Rosenfeld E, Ben-Hur R, Mizrachy A, Kelson I, Keisari Y. A New Radiation Concept, Treatment of Squamous Cell Carcinoma by Alpha-radiation Based Brachytherapy (Alpha DaRT). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.886] [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: 11/16/2022]
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21
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Callegari L, Schwarz E, Zhao X, Mor M, Rosenfeld E, Borrero S. Racial and ethnic differences in contraceptive preferences — findings from the Examining Contraceptive Use and Unmet Need among women veterans (ECUUN) study. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.103] [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]
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22
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Avishai G, Rosenfeld E, Allon DM, Gillman L, Asafrana G, Nissan J, Chaushu G. [Bone augmentation of the extremely atrophic anterior mandible, using allogeneic block grafts, via submental approach]. Refuat Hapeh Vehashinayim (1993) 2016; 33:49-74. [PMID: 30699488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Edentulous patients with advanced resorption of the mandible (atrophic mandible) suffer major discomfort when using dentures. Furthermore, placing dental implants is impossible due to lack of sufficient bone volume. In the past, several methods of bone grafting to the anterior mandible have been proposed. Most of them were unpredictable in either the short or long-term. In 2002 a technique for bone grafting of the anterior mandible via a submental approach was published. A wide reflection of the soft tissue was followed by implant placement. Autogenous particulate posterior iliac crest bone graft was used. The presence of the implants did not allow for contraction of the soft tissue and bone resorption. The addition of bone volume to the chin improved the facial aesthetics of the patients due to a fuller appearance of the chin and tightening of the skin of the neck. The submental approach changes the spatial orientation of the surgeon and placement of implants in the correct location and angle become challenging. Placement of the implants too far buccally was a prosthetic problem. A major disadvantage of autogenous bone grafting is the necessity to operate a donor site. The increasing experience in use of allogenic bone grafts with resorbable collagen membranes, allowed us to modify the submental approach for bone grafting of the anterior atrophic mandible, avoiding a donor site surgery. We chose to perform the bone graft as a first stage surgery, in which, via a submental approach allogenic bone blocks were adapted and fixated to the anterior mandible with titanium screws, xenograft and resorbable collagen membranes were used. A few months (>4) were allowed for graft consolidation and then a second stage surgery was performed, via an intraoral approach dental implants were placed. In this way we avoided loss of orientation and had a familiar setting for implant location and angulation. Five patients with atrophic mandibles were treated using this surgical protocol. Based on cone beam CT imaging, average bone height in the anterior mandible prior to treatment was 5.52 mm. After bone graft, the average gain in bone height was 12.74 mm. No major post-operative complications were noted. After bone graft consolidation, 4 or 5 dental implants were placed, most of the implants used were longer than 11.5 mm. 22 implants were placed, out of which 21 integrated (95.5%). Some of the patients were rehabilitated with overdentures and locators and some with PFM bridges. All patients were followed up for more than a year and no implant failure was recorded. Bone grafting to the anterior mandible using allogenic blocks with collagen membranes via a submental approach with second stage implant placement seems to be a viable solution for rehabilitation of the atrophic mandible.
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Rosenfeld E, Callegari L, Schwarz E, Zhao X, Mor M, Borrero S. Associations between contraceptive knowledge and use of prescription contraceptives among women veterans. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.132] [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]
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Rosenfeld E, Rauh K, Kick L, Kunath J, Günther J, Hauner H. Gesund leben in der Schwangerschaft (GeliS) – gesundheitsförderliche Ernährung von Schwangeren. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563140] [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]
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25
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Fuh K, Secord A, Bevis K, Huh W, Blansit K, Rosenfeld E, Hu L, Previs R, Gardner A, Kapp D, Chan J. Disease stabilization versus response after bevacizumab treatment in recurrent ovarian cancer: How do we determine clinical efficacy? Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.130] [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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26
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Rosenfeld E, Jenderka KV, Kopp A, Keim V. How perfect are you with defective probes? Information on the results of the mini-trial on technical quality assurance during the "Ultraschall 2012" conference in Davos. Ultraschall Med 2013; 34:185-188. [PMID: 23558398 DOI: 10.1055/s-0033-1335141] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article deals with the technical quality assurance of ultrasound B-systems. As part of a mini-trial during the Dreiländertreffen in Davos "Ultrasound 2012", we addressed the question as to whether physicians can detect faulty probes spontaneously during live scanning B-mode. For this purpose a special diagnostic device had been prepared so that groups of piezoelectric elements in the array were without function. Then the images had to be characterized by test persons without knowledge of the faulty elements. The results show that a deterioration of the image could be detected starting at five disabled elements. Due to the small number of test persons, our statements are only preliminary.
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Affiliation(s)
- E Rosenfeld
- FB Ingenieur- und Naturwissenschaften, Hochschule Merseburg, Merseburg, Germany.
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Jenderka KV, Kopp A, Liebscher E, Rosenfeld E. Simple Test Of Transducer Arrays By Imaging Of Ultrasound Emission Into Air. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-L/bmt-2013-4268/bmt-2013-4268.xml. [DOI: 10.1515/bmt-2013-4268] [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: 11/15/2022]
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Rosenfeld E, Wolter S, Kopp A, Liebscher E. Investigation of the suitability of tissue phantoms for testing the constancy of ultrasonic transducer arrays in quality assurance. Ultraschall Med 2012; 33:289-294. [PMID: 22576698 DOI: 10.1055/s-0032-1312808] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To ensure high quality ultrasound diagnostics, proper functioning of the devices used is a necessary prerequisite. Ultrasound transducers have proven to be the most failure-prone part of the signal chain. Their technical monitoring is possible in principle with the help of tissue phantoms. The background of the present study is to determine which type of phantoms and which measurement parameters are best suited to a consistency test as part of routine quality assurance of ultrasound imaging systems. MATERIALS AND METHODS A classic wire-type phantom (ATS Mod. 539, ATS Labs Bridgeport, USA) and a 3 D cyst phantom (TCC, Timelkam, Austria) were used for the studies and comparative tests were conducted between intact transducers and those in which faults had been simulated. The collected measurement data show a relatively large scatter. Therefore, statistical analysis methods were used, and the discrimination analysis proved to be a useful tool. RESULTS Local failures which arise, e. g. due to the breakdown of individual piezoelectric elements or element groups in the transducer array, can be detected with the help of the gray value targets of the ATS phantom, but only in those cases in which the error-affected sound field part actually overlaps with the target under consideration. The TCC phantom is not suitable for the detection of such errors. Global transducer failures, i. e. those that affect the entire array, can even be detected with both types of phantoms. CONCLUSION When the emphasis of quality assessment is on the detection of local defects in the array that make up the largest part of the transducer faults, studies with conventional phantoms are only of limited value.
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Affiliation(s)
- E Rosenfeld
- FB Ingenieur- und Naturwissenschaften, Hochschule Merseburg, Germany.
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Stelter L, Evans MJ, Jungbluth AA, Zanzonico P, Ritter G, Ku T, Rosenfeld E, Bomalaski JS, Old L, Larson SM. Präklinische Evaluation eines neuartigen Therapieansatzes im malignen Melanom mittels F-18 FDG PET und Fluorescence Molecular Tomography (FMT). ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311120] [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: 10/28/2022]
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Streuling I, Beyerlein A, Rosenfeld E, Hofmann H, Schulz T, von Kries R. Physical activity and gestational weight gain: a meta-analysis of intervention trials. BJOG 2010; 118:278-84. [PMID: 21134106 DOI: 10.1111/j.1471-0528.2010.02801.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND high gestational weight gain (GWG) has been found to be associated with a number of adverse perinatal and long-term outcomes. OBJECTIVES we aimed to perform a systematic review and meta-analysis to find out whether physical activity in pregnancy might help avoid high GWG. SEARCH STRATEGY a literature search in relevant databases and an additional search by hand through bibliographies of various publications were performed. SELECTION CRITERIA we included randomised controlled trials on healthy women, with increased physical activity as the only intervention. GWG had to be documented for the intervention and control group separately. DATA COLLECTION AND ANALYSIS two reviewers independently extracted data and performed quality assessment. Data from the included trials were combined using a random-effects model. The effect size was expressed as mean difference (MD). MAIN RESULTS of 1380 studies identified, 12 trials met the inclusion criteria. In seven trials, GWG was lower in the exercise group compared with the control group, whereas five trials showed a lower GWG in the control groups. The meta-analysis resulted in an MD of GWG of -0.61 (95% CI: -1.17, -0.06), suggesting less GWG in the intervention groups compared with the control groups. We found no indication for publication bias or dose effects. AUTHOR'S CONCLUSIONS in summary, our analyses suggest that physical activity during pregnancy might be successful in restricting GWG.
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Affiliation(s)
- I Streuling
- Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University of Munich, Munich, Germany.
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Shay B, Gruenbaum-Cohen Y, Tucker AS, Taylor AL, Rosenfeld E, Haze A, Dafni L, Leiser Y, Fermon E, Danieli T, Blumenfeld A, Deutsch D. High yield expression of biologically active recombinant full length human tuftelin protein in baculovirus-infected insect cells. Protein Expr Purif 2009; 68:90-8. [PMID: 19539764 DOI: 10.1016/j.pep.2009.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 06/15/2009] [Accepted: 06/15/2009] [Indexed: 11/16/2022]
Abstract
Tuftelin is an acidic protein expressed at very early stages of mouse odontogenesis. It was suggested to play a role during epithelial-mesenchymal interactions, and later, when enamel formation commences, to be involved in enamel mineralization. Tuftelin was also detected in several normal soft tissues of different origins and some of their corresponding cancerous tissues. Tuftelin is expressed in low quantities, and undergoes degradation in the enamel extracellular matrix. To investigate the structure and function of tuftelin, the full length recombinant human tuftelin protein was produced. The full length human tuftelin cDNA was cloned using Gateway recombination into the Bac-to-Bac system compatible transfer vector pDest10. This vector adds a hexahistidine tag to the N-terminus of the expressed protein, enabling one-step affinity purification on nickel column. The recombinant human tuftelin protein was transposed into the bacmid and expressed in Spodoptera frugiperda (Sf9) insect cells. The yield of the purified, his-tagged recombinant full length human Tuftelin (rHTuft+) was 5-8 mg/L culture. rHTuft+ was characterized by SDS-PAGE, Western blot, ESI-TOF spectrometry, restriction mapping and MS/MS sequencing. The availability of the purified, full length recombinant human tuftelin protein opened up the possibility to investigate novel functions of tuftelin. Application of rHTuft+ agarose beads onto embryonic mouse mandibular explants caused changes in the surrounding epithelial cells, including morphology, orientation and spatial organization. Further studies using DiI labeling, revealed that rHTuft+, placed on the tooth germ region, brought about recruitment of adjacent embryonic mesenchymal cells. These findings support the hypothesis that tuftelin plays an important role during embryogenesis.
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Affiliation(s)
- B Shay
- Dental Research Laboratory, Institute of Dental Sciences, Hebrew University-Hadassah Faculty of Dental Medicine, Israel
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Marchand P, Rosenfeld E, Erable B, Maugard T, Lamare S, Goubet I. Coupled oxidation–reduction of butanol–hexanal by resting Rhodococcus erythropolis NCIMB 13064 cells in liquid and gas phases. Enzyme Microb Technol 2008. [DOI: 10.1016/j.enzmictec.2008.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zigha A, Rosenfeld E, Schmitt P, Duport C. Anaerobic cells of Bacillus cereus F4430/73 respond to low oxidoreduction potential by metabolic readjustments and activation of enterotoxin expression. Arch Microbiol 2006; 185:222-33. [PMID: 16470372 DOI: 10.1007/s00203-006-0090-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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: 11/03/2005] [Revised: 01/13/2006] [Accepted: 01/18/2006] [Indexed: 10/25/2022]
Abstract
In the present study, a food-borne pathogen strain of Bacillus cereus (F4430/73) was anaerobically grown in controlled-batch conditions under low initial oxidoreduction potential (ORP=-148 mV) using hydrogen gas as reducing agent. Its physiological characteristics, including growth, glucose fermentation capacity and enterotoxin production, were compared with anaerobic conditions generated by nitrogen gas (ORP=+ 45 mV). The results showed that low ORP affected growth mainly during the early stages. Maximal specific rates of growth and glucose consumption were reduced, and drastic changes in time profiles of fermentation product concentration were observed. Production of lactate was promoted at the expense of acetate. Nevertheless, low ORP did not affect final biomass yield. Under both ORP conditions, Non-haemolytic enterotoxin (Nhe) was produced early during the exponential growth phase as a first enterotoxin and Haemolysin BL (Hbl) later during the early stationary growth phase as a second enterotoxin. The major effect of low ORP was the strong stimulation of Hbl production and, to a lesser extent, Nhe production. This control was complex, involving different levels of regulation. We discussed the regulation of enterotoxin expression and the involvement of the pleiotropic regulator PlcR.
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Affiliation(s)
- A Zigha
- UMR A 408 Université d'Avignon et des Pays de Vaucluse & INRA, Domaine Saint Paul, 84914 Avignon cedex, France
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Schmelzer C, Żwirbla W, Rosenfeld E, Linde B. Acoustic investigations of pseudo-stable structures in aqueous solutions of polyethylene glycols. J Mol Struct 2004. [DOI: 10.1016/j.molstruc.2004.04.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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Deutsch D, Leiser Y, Shay B, Fermon E, Taylor A, Rosenfeld E, Dafni L, Charuvi K, Cohen Y, Haze A, Fuks A, Mao Z. The human tuftelin gene and the expression of tuftelin in mineralizing and nonmineralizing tissues. Connect Tissue Res 2003; 43:425-34. [PMID: 12489194 DOI: 10.1080/03008200290001186] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [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: 02/03/2023]
Abstract
Tuftelin has been suggested to play an important role during the development and mineralization of enamel, but its precise function is still unclear. This article reviews major milestones in the discovery, structural characterization, expression, localization, and conservation of tuftelin in different vertebrate species. It focuses on the structure of the human tuftelin gene, which has recently been deciphered [12]. It describes the exon-intron organization, sizes and structure, the promoter structure, and the newly discovered alternatively spliced human tooth-bud tuftelin mRNA transcripts. It also examines information on the structural motifs in the human-derived tuftelin protein and how they relate to tuftelin from other species. It reviews our recent results on the transcription of tuftelin mRNA and protein expression in several nonmineralizing soft tissues, using reverse-transcription polymerase chain reaction (RT-PCR) followed by DNA cloning and sequencing, indirect immunohistochemistry, immunohistochemistry combined with confocal microscopy, and in situ hybridization. These results and earlier Northern blot results show that tuftelin, in addition to being expressed in the developing and mineralizing tooth, is also expressed in several nonmineralizing soft tissues, suggesting that tuftelin has a universal function and/or a multifunctional role.
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Affiliation(s)
- D Deutsch
- Institute of Dental Sciences, Dental Research Unit, Department of Oral Biology, Hebrew University, Hadassah Faculty of Dental Medicine, PO Box 12272, Jerusalem, Israel 91120.
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Abstract
The non-thermal, non-cavitational (NTNC-) effects of medical ultrasound are based essentially on the direct and indirect effects of the sound radiation pressure. This article introduces the biophysics of the basic mechanisms and describes possible clinical implications using selected examples. It has been determined that generally no additional risks ensue through the effects of NTNC used purely for diagnostic purposes. Significant effects can only be detected under the conditions which prevail during therapeutic exposure. The question as to whether the pulse Doppler technique is completely harmless cannot be answered conclusively at this time. The synergetic effects between ultrasound and contrast media have not yet been examined thoroughly.
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Affiliation(s)
- E Rosenfeld
- Fachhochschule Merseburg, FB Informatik und Angewandte Naturwissenschaften.
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Kavanagh B, Wu Q, Arnfield M, Segreti E, West R, Benedict S, Rosenfeld E, Fulcher A, Manning M, Mohan R. 2260 Whole pelvic intensity-modulated radiotherapy (IMRT) for cervix cancer using a “butterfly” isodose plan: In vivo dosimetric verification of reduced rectal dose and clinical feasibility evaluation. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90528-x] [Citation(s) in RCA: 4] [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: 10/26/2022]
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Phillips P, Wilson D, Beilby J, Taylor A, Rosenfeld E, Hill W, Parsons J. Diabetes complications and risk factors in an Australian population. How well are they managed? Int J Epidemiol 1998; 27:853-9. [PMID: 9839743 DOI: 10.1093/ije/27.5.853] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 11/15/2022] Open
Abstract
BACKGROUND This study aimed to explore the relationship between complications and risk factors in the type 2 diabetes population, and to assess the level of assistance people with diabetes receive in controlling their risk factors. METHODS Participants were recruited from representative population surveys of South Australians aged over 18 years. Participants were asked a series of questions about their risk factors and the advice and assistance they received from their general practitioner (GP) in modifying their risk factors. Additionally, participants were clinically tested for a number of macro and microvascular complications. RESULTS South Australians with type 2 diabetes have a high prevalence of risk factors, with the majority being overweight or obese, doing no vigorous exercise and having high blood pressure. They also have a high prevalence of complications, with 53% having at least one macrovascular complication and 66% having at least one microvascular complication. Additionally, participants reported high levels of GP advice and assistance on the risk factors where pharmacological controls were available, but low levels of assistance where non-pharmacological interventions were needed to control the risk factor. CONCLUSIONS The prevalence of diabetes risk factors and complications among South Australians with type 2 diabetes is a cause for concern, as is the lack of assistance offered by GPs to modify risk factors. Multi-disciplinary approaches to the control of risk factors and patient self-management and education are critical to the progression and success of diabetes care.
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Affiliation(s)
- P Phillips
- Endocrine & Diabetes Service, Queen Elizabeth Hospital, Woodville, South Australia
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Abstract
As part of an initiative to develop a smoking cessation resource tailored to the needs of smokers with diabetes, we undertook a survey of 223 people with insulin-dependent diabetes (IDDM) aged 15-40 years, 54 of whom were smokers. Smokers had high levels of awareness that smoking increases the risk of heart and peripheral vascular disease, but were less aware of the risk of microvascular complications. Nearly half of the smokers had other members of the household who were smokers, and 56% indicated they would expect to receive no more than a little encouragement from friends and family members to quit. Concern about weight gain and dietary adherence was a barrier to quitting smoking for approximately one-third of smokers. Seventy percent of smokers recalled advice to quit smoking from a general practitioner, but this most often had involved minimal advice to quit. There is scope for patient education with respect to microvascular complications exacerbated by smoking, and a need to consider the smoking habits of other household members and enlist their active support for smoking cessation.
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Affiliation(s)
- M Wakefield
- Epidemiology Branch, South Australian Health Commission, Australia.
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41
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Abstract
Coupled processes of diffusion and chemical reaction are quantitatively analyzed by means of proton concentration profile measurements in the immediate membrane vicinity. Because mass transfer across the unstirred layer (USL) is thought to proceed via diffusion, only the size of the USL is used as a scale for diffusion restrictions. Limitations associated with the finiteness of the reaction rate are characterized by the size of the reaction layer (RL). The latter is defined as the distance from the membrane where equilibrium is reached if transmembrane diffusion is followed by chemical reactions proceeding in the solution layers adjacent to the membrane. The well-known reaction of acetaldehyde oxidation catalyzed by alcohol dehydrogenase in the presence of NADH was selected because it is accompanied by an easily measurable alkalinization of the solution. The enzyme/coenzyme and the substrate were added to opposite sides of the membrane. A theoretical model describing the reaction and diffusion kinetics enabled us to calculate the size of the RL from the pH profile within the USL of a planar bilayer membrane showing a high proton permeability. As the enzyme concentration increased, the initially reaction-limited kinetics of the total turnover became diffusion limited under our experimental conditions due to a dramatic shortening of the RL.
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Affiliation(s)
- Y N Antonenko
- Medical Department, Martin-Luther-University, Halle, Germany
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42
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Kenyon TA, Izurieta H, Shulman ST, Rosenfeld E, Miller M, Daum R, Strebel PM. Large outbreak of pertussis among young children in Chicago, 1993: investigation of potential contributing factors and estimation of vaccine effectiveness. Pediatr Infect Dis J 1996; 15:655-61. [PMID: 8858667 DOI: 10.1097/00006454-199608000-00004] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND An outbreak of pertussis from July, 1993, to April, 1994, in Chicago was investigated to identify potential contributing factors. METHODS Surveillance was enhanced to identify cases. Information from a vaccination coverage survey was used to define a retrospective cohort to estimate vaccine effectiveness of three or more doses of pertussis vaccine. RESULTS The median age of 218 reported cases was 8 months, 46% had Hispanic surnames and cases were clustered geographically. Vaccination status was known for 173 of 191 (91%) children younger than 6 years of age. Of these 173, 90 (52%) were younger than 7 months, and 35 (20%) children at least 7 months of age had received fewer than 3 doses of pertussis vaccine. Pertussis vaccine effectiveness was 76% (95% confidence interval, 29 to 92). CONCLUSIONS The limited ability of the current pertussis vaccination schedule to protect young infants accounted for 52% of cases, primary vaccine failure accounted for 28% of cases and failure to vaccinate children on time accounted for 20% of cases in young children. Low vaccine effectiveness did not appear to be a contributing factor.
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Affiliation(s)
- T A Kenyon
- Communicable Disease Division, Chicago Department of Health, IL, USA
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43
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Rosenfeld E, Salimi B, O'Gorman MR, Lawyer C, Katz BZ. Potential in vitro activity of Kutapressin against Epstein-Barr virus. In Vivo 1996; 10:313-8. [PMID: 8797033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kutapressin (KU), a porcine liver extract with bradykinin-potentiating effects but no vitamin B 12 activity, has been used in the treatment of Herpes zoster. We examined a phenol-free preparation of this drug for in vitro activity against Epstein-Barr Virus (EBV). MATERIALS AND METHODS Immortalization-inhibition assays were used to assess EBV infectivity. Mitogen stimulation and cell viability assays were used to assess kutapression toxicity. Lytic replication assays and flow cytometry were used to assess the mechanism of drug activity. RESULTS Seventy-five hundred mcg/ml of KU blocked the infection of 2 x 10(5) human umbilical cord mononuclear cells when added together with two strains of EBV (B95-8 and FF41). Doses as low as 250 mcg/ml were occasionally effective as well. Unlike acyclovir, KU does not inhibit viral DNA polymerase nor does it appear to compete with EBV as it binds to its receptor on the B-cell surface. CONCLUSIONS The mechanism whereby KU may inhibit EBV immortalization remains to be determined. KU, a drug which is safe in humans, deserves further study as an agent with potential to block EBV-induced immortalization of B-lymphocytes.
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Affiliation(s)
- E Rosenfeld
- Department of Pediatrics, Northwestern University Medical School, Children's Memorial Hospital, Chicago, IL 60614, USA
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45
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Pohl P, Antonenko YN, Rosenfeld E. Effect of ultrasound on the pH profiles in the unstirred layers near planar bilayer lipid membranes measured by microelectrodes. Biochim Biophys Acta 1993; 1152:155-60. [PMID: 8399294 DOI: 10.1016/0005-2736(93)90242-r] [Citation(s) in RCA: 39] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A pH shift in the unstirred layers (USLs) near a planar lipid bilayer membrane was induced by the diffusion of acetic acid along a concentration gradient. By means of a microelectrode technique it was shown that ultrasound decreases the thickness of the USL and that this reduction was much more pronounced on the side facing the ultrasound transducer than on the opposite side of the membrane. The effect depending on sound frequency and pressure is caused by the unidirectional fluid flow built up between transducer surface and membrane, the so-called quartz wind. Theoretical considerations based on the equations of the acoustic streaming near interfaces combined with the diffusion equation allow to predict the thickness of the USL if the sound field parameters are known.
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Affiliation(s)
- P Pohl
- Department of Medical Physics and Biophysics, Martin Luther University, Halle, Germany
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46
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Pohl P, Rosenfeld E, Millner R. Effects of ultrasound on the steady-state transmembrane pH gradient and the permeability of acetic acid through bilayer lipid membranes. Biochim Biophys Acta 1993; 1145:279-83. [PMID: 8431460 DOI: 10.1016/0005-2736(93)90300-o] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The irradiation of bilayer lipid membranes with continuous ultrasound of a frequency of 8.2 MHz and a spacial peak time average (SPTA) intensity of 0.4 W/cm2 reduces the thickness of the unstirred layer up to 40% of its initial value under our conditions. This result was obtained from measurements of the transmembrane potential which appears after the addition of a protonophore in the presence of a gradient of acetic acid. Ultrasound exposure decreases this potential when the pH of the buffer solutions is much higher than the pK of CH3COOH and has no effect at low pH values. The latter can be explained by a simultaneous increase of the permeability of acetic acid and the buffer substances, respectively, due to ultrasound irradiation.
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Affiliation(s)
- P Pohl
- Department of Applied Biophysics, Martin Luther University, Halle-Wittenberg, Germany
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47
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Gioseffi ON, Alfonso G, Rosenfeld E, Briend S, Cohen R. [Meningeal myelomatosis. Presentation of a case]. Sangre (Barc) 1992; 37:137-9. [PMID: 1621184] [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: 12/27/2022]
Abstract
The case of a 36-year old man with IgA kappa multiple myeloma in whom meningeal myelomatosis developed is reported, and a brief review of previously published cases is made. Meningeal involvement develops in patients with high tumoral mass myeloma. Because of its poor prognosis, central nervous system chemoprophylaxis based on clinical and cerebrospinal fluid data, and systemic treatment according to severity, is suggested.
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Affiliation(s)
- O N Gioseffi
- Hospital Nacional Profesor Alejandro Posadas, Servicio de Hematología, Buenos Aíres, Republica Argentina
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48
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Rosenfeld E, Klemenz A, Cobet U. Ein modifiziertes Ultraschall-Dopplerverfahren zum semiquantitativen Nachweis von gashaltigen Kontrastmitteln in vivo und in vitro. BIOMED ENG-BIOMED TE 1991. [DOI: 10.1515/bmte.1991.36.s1.120] [Citation(s) in RCA: 2] [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: 11/15/2022]
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Abstract
Photodynamic action promoted by Rose Bengal was evaluated in solutions of unsaturated fatty acids or histidine, and on beef heart submitochondrial particles. Rose Bengal-promoted photooxidation of histidine was mainly due to the opening up of the imidazole ring by singlet oxygen. Photosensitization of polyunsaturated fatty acids (PUFA) resulted in oxygen consumption and thiobarbituric acid-reactive substances (TBARS) formation, the extent of which was linearly related to the increasing degree of unsaturation. Photosensitization of submitochondrial particles caused oxygen consumption and TBARS production. These processes involved two different reaction components: during the first, most of the mitochondrial proteins were inactivated, the most sensitive being succinate dehydrogenase and cytochrome c. The values for the rate ratios of [TBARS] formation/[O2] consumption for the first and second phase were 0.36 and 1.32%, respectively, pointing to a larger contribution of lipid peroxidation during the second phase. The calculation of the rate constants for reaction of singlet oxygen with mitochondrial proteins suggests that singlet oxygen is more reactive towards proteins than to PUFA. The biological role of this selectivity is discussed in terms of the mitochondria as one of the first targets for photosensitized reactions.
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Affiliation(s)
- C Giulivi
- Department of Physical Chemistry, School of Pharmacy and Biochemistry, University of Buenos Aires, Argentina
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50
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Abstract
Rose bengal photosensitized the formation of frank single-strand breaks (SSBs) in double-stranded, supercoiled pBR322 DNA as measured by neutral agarose electrophoresis. The yield of SSBs followed first order kinetics with respect to light fluence and dye concentration. The efficiency of cleavage was more than 20 times greater in an argon atmosphere than in an oxygen atmosphere. The quantum yield in an air atmosphere was 1.7 (+/- 0.3) X 10(-8). Sodium azide quenched the cleavage more efficiently in an oxygen atmosphere than when the oxygen concentration was reduced. Isopropanol and mannitol were poor quenchers; ribose-5-phosphate and guanosine-5'-monophosphate did not quench the cleavage. Substituting D2O for H2O increased the yield of SSBs in both oxygen and oxygen-depleted atmospheres. The results are consistent with initiation of cleavage by reaction of the triplet state of rose bengal (or a radical derived from it) with DNA. In the presence of oxygen, an additional mechanism is introduced.
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