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Dong J, Grant C, Vuong B, Nishioka N, Gao AH, Beatty M, Baldwin G, Bailargeon A, Bablouzian A, Grahmann P, Bhat N, Ryan E, Barrios A, Giddings S, Ford T, Beaulieu-Ouellet E, Hosseiny SH, Lerman I, Trasischker W, Reddy R, Singh K, Gora M, Hyun D, Queneherve L, Wallace M, Wolfsen H, Sharma P, Wang KK, Leggett CL, Poneros J, Abrams JA, Lightdale C, Leeds S, Rosenberg M, Tearney G. Feasibility and Safety of Tethered Capsule Endomicroscopy in Patients With Barrett's Esophagus in a Multi-Center Study. Clin Gastroenterol Hepatol 2022; 20:756-765.e3. [PMID: 33549871 PMCID: PMC8715859 DOI: 10.1016/j.cgh.2021.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 01/08/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Tethered capsule endomicroscopy (TCE) involves swallowing a small tethered pill that implements optical coherence tomography (OCT) imaging, procuring high resolution images of the whole esophagus. Here, we demonstrate and evaluate the feasibility and safety of TCE and a portable OCT imaging system in patients with Barrett's esophagus (BE) in a multi-center (5-site) clinical study. METHODS Untreated patients with BE as per endoscopic biopsy diagnosis were eligible to participate in the study. TCE procedures were performed in unsedated patients by either doctors or nurses. After the capsule was swallowed, the device continuously obtained 10-μm-resolution cross-sectional images as it traversed the esophagus. Following imaging, the device was withdrawn through mouth, and disinfected for subsequent reuse. BE lengths were compared to endoscopy findings when available. OCT-TCE images were compared to volumetric laser endomicroscopy (VLE) images from a patient who had undergone VLE on the same day as TCE. RESULTS 147 patients with BE were enrolled across all sites. 116 swallowed the capsule (79%), 95/114 (83.3%) men and 21/33 (63.6%) women (P = .01). High-quality OCT images were obtained in 104/111 swallowers (93.7%) who completed the procedure. The average imaging duration was 5.55 ± 1.92 minutes. The mean length of esophagus imaged per patient was 21.69 ± 5.90 cm. A blinded comparison of maximum extent of BE measured by OCT-TCE and EGD showed a strong correlation (r = 0.77-0.79). OCT-TCE images were of similar quality to those obtained by OCT-VLE. CONCLUSIONS The capabilities of TCE to be used across multiple sites, be administered to unsedated patients by either physicians or nurses who are not expert in OCT-TCE, and to rapidly and safely evaluate the microscopic structure of the esophagus make it an emerging tool for screening and surveillance of BE patients. Clinical trial registry website and trial number: NCT02994693 and NCT03459339.
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Affiliation(s)
- Jing Dong
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Catriona Grant
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Barry Vuong
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Norman Nishioka
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Anna Huizi Gao
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Matthew Beatty
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Grace Baldwin
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Aaron Bailargeon
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Ara Bablouzian
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Patricia Grahmann
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Nitasha Bhat
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Emily Ryan
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Amilcar Barrios
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Sarah Giddings
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Timothy Ford
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | | | | | - Irene Lerman
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Wolfgang Trasischker
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Rohith Reddy
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Kanwarpal Singh
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Michalina Gora
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA,ICube Laboratory, CNRS, Strasbourg University, France
| | - Daryl Hyun
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Lucille Queneherve
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Michael Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL
| | - Herbert Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City Veterans Administration and University of Kansas School of Medicine, MO
| | - Kenneth K. Wang
- Division of Gastroenterology and Hepatology,, Mayo Clinic Rochester, MN
| | - Cadman L. Leggett
- Division of Gastroenterology and Hepatology,, Mayo Clinic Rochester, MN
| | | | | | | | | | - Mireille Rosenberg
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Guillermo Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA,Department of Pathology, Massachusetts General Hospital, MA,Harvard-MIT Division of Health Science and Technology (HST)
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Freeman K, Lerman I, Kranias EG, Bohlmeyer T, Bristow MR, Lefkowitz RJ, Iaccarino G, Koch WJ, Leinwand LA. Alterations in cardiac adrenergic signaling and calcium cycling differentially affect the progression of cardiomyopathy. J Clin Invest 2001; 107:967-74. [PMID: 11306600 PMCID: PMC199560 DOI: 10.1172/jci12083] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The medical treatment of chronic heart failure has undergone a dramatic transition in the past decade. Short-term approaches for altering hemodynamics have given way to long-term, reparative strategies, including beta-adrenergic receptor (betaAR) blockade. This was once viewed as counterintuitive, because acute administration causes myocardial depression. Cardiac myocytes from failing hearts show changes in betaAR signaling and excitation-contraction coupling that can impair cardiac contractility, but the role of these abnormalities in the progression of heart failure is controversial. We therefore tested the impact of different manipulations that increase contractility on the progression of cardiac dysfunction in a mouse model of hypertrophic cardiomyopathy. High-level overexpression of the beta(2)AR caused rapidly progressive cardiac failure in this model. In contrast, phospholamban ablation prevented systolic dysfunction and exercise intolerance, but not hypertrophy, in hypertrophic cardiomyopathy mice. Cardiac expression of a peptide inhibitor of the betaAR kinase 1 not only prevented systolic dysfunction and exercise intolerance but also decreased cardiac remodeling and hypertrophic gene expression. These three manipulations of cardiac contractility had distinct effects on disease progression, suggesting that selective modulation of particular aspects of betaAR signaling or excitation-contraction coupling can provide therapeutic benefit.
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Affiliation(s)
- K Freeman
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado, Boulder, CO 80309-0347, USA
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Abstract
OBJECTIVES Several studies have demonstrated that a large percentage of older people are inadequately immunized against tetanus. The aim of this study was to assess the immunity against tetanus in a group of individuals aged 69 and older and to examine the immune response to a single dose of tetanus toxoid. DESIGN A convenience sample of 115 residents of a large retirement home, aged 69 and older, was studied. After a blood sample for anti-tetanus antibody titer, a single dose of tetanus toxoid vaccine was administered. Repeat titers were obtained 6 weeks after the vaccination and analyzed by ELISA assay. Antibody levels equal to or greater than 0.1 IU/mL were considered protective. RESULTS Sixty-seven of 115 (58.3%) individuals had adequate antibody titers. Those individuals who reported having been vaccinated with tetanus toxoid in the past were more likely to be immunized adequately compared with those who reported having never been vaccinated (66.7% vs 39.3%, P = .02). After vaccination, 34 of 46 (73.9%) individuals with inadequate antibody titers became seropositive. Those who remained seronegative had mean prevaccination antibody titers significantly lower than those who seroconverted. Sixteen of 17 (94.1%) persons who reported having been vaccinated in the past and were found to be seronegative developed adequate antibody titers following vaccination, compared with only nine of 16 (56.2%) who reported never having been vaccinated (P = .04). There was no association between seroconversion rate and age, sex, underlying diseases, and army service. CONCLUSIONS Most individuals will develop an adequate anti-tetanus antibody titer following administration of a single dose of tetanus vaccine. A history of past immunization is a good predictor of becoming adequately immunized. It is important that physicians follow the current recommendations for adult immunization and initiate campaigns to ensure that the older population is protected against tetanus.
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Affiliation(s)
- T Shohat
- Tel-Aviv Health District and the Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Israel
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del Rincón JP, Lerman I, Vázquez-Lamadrid J, Gómez-Pérez FJ, Granados J, Morales JJ, Mutchinick O. Hypopituitarism in Two Brothers Born by Breech Delivery. Endocr Pract 1999; 5:143-7. [PMID: 15251687 DOI: 10.4158/ep.5.3.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe two brothers with hypopituitarism who had been born by breech delivery and to discuss whether this condition corresponds to a familial form or to a pituitary stalk section as a result of the breech delivery. METHODS We present the clinical, biochemical, and magnetic resonance imaging (MRI) characteristics of two Mexican brothers, 19 and 21 years old, with hypopituitarism and a history of breech delivery. RESULTS Physical examination of both patients showed short stature with normal body proportions, an obviously younger appearance than that expected for their chronologic age, high-pitched voice, irregularly positioned teeth, no axillary or pubic hair, and prepubertal genitalia. Biochemical testing showed low thyroxine and free thyroxine values with inadequate or normal thyrotropin, low basal testosterone, and mildly increased serum prolactin levels. Stimulation tests showed a normal and a delayed thyrotropin response to thyrotropin-releasing hormone, subnormal serum cortisol, considerably blunted growth hormone (GH) response to insulin-induced hypoglycemia, and absence of GH response to GH-releasing hormone in both cases. MRI showed an ectopic neuropituitary gland. In case 1, a caudal portion of a very thin pituitary stalk was observed, suggesting the preservation of a vascular component of the stalk. Because both parents of these brothers shared the major histocompatibility complex haplotype HLA-A*2301, B*3501, DRB1*0407, DQA1*03, DQB1*0201, consanguinity was suggested. CONCLUSION The phenotype of these patients differs from that described in families with POU1F1 (Pit-1) and PROP1 mutations. These cases are most likely related to an autosomal recessive gene mutation that warrants further research. To our knowledge, this is the first report of hypopituitarism in two brothers born by breech delivery.
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Affiliation(s)
- J P del Rincón
- Department of Endocrinology, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico
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Bautista-Martinez S, Aguilar-Salinas CA, Lerman I, Velasco ML, Castellanos R, Zenteno E, Guillen LE, Murcio R, Wong B, Gómez Pérez FJ, Rull-Rodrigo JA. Diabetes knowledge and its determinants in a Mexican population. Diabetes Educ 1999; 25:374-81. [PMID: 10531857 DOI: 10.1177/014572179902500308] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to measure the level of diabetes knowledge in a representative group of Mexican individuals with diabetes and to identify the factors that influence it. METHODS A validated questionnaire was administered to 570 outpatients; 11.2% had Type 1 diabetes, 36.4% had Type 2 diabetes treated with insulin, and 52.2% had Type 2 diabetes treated with oral agents. Samples for HbA1c determination also were obtained. RESULTS The percentage of correct answers in each section of the questionnaire was low. Type 1 patients had the highest scores, followed by the insulin-treated Type 2 patients; those with chronic complications also had high scores. Educational background, attendance at diabetes courses, age, and HbA1c concentration were the main predictors of knowledge. Attendance at courses was influenced by the severity of the disease. CONCLUSIONS The amount of patient knowledge about diabetes-related issues was low in this representative Mexican population. The educational efforts were focused on those with the worst metabolic control and/or with diabetes complications.
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Affiliation(s)
- S Bautista-Martinez
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - C A Aguilar-Salinas
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - I Lerman
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - M L Velasco
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - R Castellanos
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - E Zenteno
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - L E Guillen
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - R Murcio
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - B Wong
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - F J Gómez Pérez
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - J A Rull-Rodrigo
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
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Schmidt L, Li F, Brown RS, Berg S, Chen F, Wei MH, Tory K, Lerman I, Zbar B. Mechanism of tumorigenesis of renal carcinomas associated with the constitutional chromosome 3;8 translocation. Cancer J Sci Am 1995; 1:191-195. [PMID: 9166475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE Members of a family carrying a constitutional balanced translocation [t(3;8) (p14;q24)] have a high risk of developing multiple, bilateral clear-cell renal carcinomas. Two genetic mechanisms of carcinogenesis for this malignancy have been proposed: (1) disruption of a gene at the translocation breakpoint and (2) mutation of the von Hippel-Lindau tumor-suppressor gene at 3p25. This study further evaluates the role of the von Hippel-Lindau gene in the etiology and pathogenesis of t(3;8)-associated renal carcinomas. METHODS Two new t(3;8)-associated renal carcinomas were tested for mutations in the von Hippel-Lindau gene by single-stranded conformational polymorphism analysis followed by direct DNA sequencing, for loss of alleles on chromosomes 3p and 8, and for methylation abnormalities in the first cloned exon of the von Hippel-Lindau gene. RESULTS A missense mutation in the von Hippel-Lindau gene was found in one of the two t(3;8)-associated renal carcinomas. This mutation would produce a stop codon and a truncated protein. Both tumors showed a loss of alleles on the derivative 8 chromosome. When these results were combined with the results of our previous studies, two of the four t(3;8)-associated renal carcinomas, which were examined for molecular genetic changes, showed different von Hippel-Lindau somatic mutations. All renal tumors from the 3;8 translocation family showed loss of the translocated portion of chromosome 3. CONCLUSIONS These results support a mechanism of tumorigenesis in the chromosome (3;8) translocation family that involves the loss of both copies of the von Hippel-Lindau gene.
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Affiliation(s)
- L Schmidt
- Biological Carcinogenesis and Development Program, Program Resources, Inc./DynCorp, USA
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