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Kudel I, Russell P, Moyer J, Shamsi Z, Curry HA, Pitz M. Comprehensive Use of a Multifunction Software Tool to Facilitate Education and Communication of Treatment-Related Distress in Patients with Cancer Receiving Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e242-e243. [PMID: 37784953 DOI: 10.1016/j.ijrobp.2023.06.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Real-time reporting of patient-reported cancer radiation treatment symptoms via mobile app or computer-based system can improve communication with the Clinical Care Team (CCT) however single-purpose solutions can be impractical. This study describes use of multifunction software and associated patient satisfaction. MATERIALS/METHODS Patients receiving thoracic, pelvic, or bone radiation therapy at a provincial cancer agency were asked to enroll and receive training on app use. Clinical teams can send tailored educational materials (12 PDFs, 1 file linking patients to facility resources pertinent to treatment). During active treatment, the CCT also uses the software to administer the Edmonton Symptom Assessment System (ESAS) questionnaire once weekly for 4 consecutive weeks. Patients can also complete it ad hoc. The ESAS asks patients to report function across 10 domains using an 11-point scale (range 0-10); the version within the app is enhanced by programmed clinical alerts correlated to the response. When patients report pain, nausea, shortness of breath, or depression as a 7 or 8, then the response is flagged as "urgent"; if patients report a 9 or 10 then it is an "emergency". All the other items are considered "urgent" if the patient reports a 9 or 10. Upon completing the questionnaire, patients with flagged responses receive programmed recommendations, and a CCT member follows up with further instructions. Additionally, the software triages patient responses in order of urgency on the CCT's dashboard. Patients also have ad hoc use of a diary, to record any personal information, and the ability to securely communicate medical and non-medical information with the CCT. Patient satisfaction with the software was assessed by randomly asking patients with active accounts >30 days, "How likely are you to recommend (software name) to another patient" using an 11-point scale. Data for 180 days of software use were downloaded (Jan. 17) and analyzed descriptively. RESULTS Patients (n = 1,647) were sent educational information and 69.94% opened the files in less than 1 day; the median time to open was 2 hours. The ESAS was completed by 561 patients a total of 2,452 times (mean = 4.37). The CCT received 39 (1.59%) emergency alerts and 299 (12.19%) urgent alerts. The diary and secure communication features were used by 5.32% of patients. The mean satisfaction score was 7.87 (n = 176); 88 patients (50.00%) rated the app a 9 (n = 17; 9.66%) or 10 (n = 71; 40.34%). CONCLUSION The implementation of patient-facing multifunction software to those receiving radiation has, so far, been a success because it complements standard treatment care, facilitates CCT-patient partnership, enhances continuity of care, and is well-liked by patients.
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Affiliation(s)
- I Kudel
- Varian, a Siemens Healthineers Company, Palo Alto, CA
| | - P Russell
- Varian, a Siemens Healthineers Company, Palo Alto, CA
| | - J Moyer
- Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Z Shamsi
- Varian, a Siemens Healthineers Company, Palo Alto, CA
| | - H A Curry
- Varian, a Siemens Healthineers Company, Palo Alto, CA
| | - M Pitz
- University of Manitoba, Winnipeg, MB, Canada
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Moyer J, Wilson MW, Sorrentino TA, Santandreu A, Chen C, Hu D, Kerdok A, Porock E, Wright N, Ly J, Blaha C, Frassetto LA, Fissell WH, Vartanian SM, Roy S. Renal Embolization-Induced Uremic Swine Model for Assessment of Next-Generation Implantable Hemodialyzers. Toxins (Basel) 2023; 15:547. [PMID: 37755973 PMCID: PMC10536310 DOI: 10.3390/toxins15090547] [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] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
Reliable models of renal failure in large animals are critical to the successful translation of the next generation of renal replacement therapies (RRT) into humans. While models exist for the induction of renal failure, none are optimized for the implantation of devices to the retroperitoneal vasculature. We successfully piloted an embolization-to-implantation protocol enabling the first implant of a silicon nanopore membrane hemodialyzer (SNMHD) in a swine renal failure model. Renal arterial embolization is a non-invasive approach to near-total nephrectomy that preserves retroperitoneal anatomy for device implants. Silicon nanopore membranes (SNM) are efficient blood-compatible membranes that enable novel approaches to RRT. Yucatan minipigs underwent staged bilateral renal arterial embolization to induce renal failure, managed by intermittent hemodialysis. A small-scale arteriovenous SNMHD prototype was implanted into the retroperitoneum. Dialysate catheters were tunneled externally for connection to a dialysate recirculation pump. SNMHD clearance was determined by intermittent sampling of recirculating dialysate. Creatinine and urea clearance through the SNMHD were 76-105 mL/min/m2 and 140-165 mL/min/m2, respectively, without albumin leakage. Normalized creatinine and urea clearance measured in the SNMHD may translate to a fully implantable clinical-scale device. This pilot study establishes a path toward therapeutic testing of the clinical-scale SNMHD and other implantable RRT devices.
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Affiliation(s)
- Jarrett Moyer
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
- Silicon Kidney, San Ramon, CA 94583, USA
| | - Mark W. Wilson
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
| | - Thomas A. Sorrentino
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
| | - Ana Santandreu
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
| | - Caressa Chen
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
| | - Dean Hu
- Outset Medical, San Jose, CA 95134, USA
| | | | - Edward Porock
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
| | - Nathan Wright
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
- Silicon Kidney, San Ramon, CA 94583, USA
| | - Jimmy Ly
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
- Silicon Kidney, San Ramon, CA 94583, USA
| | - Charles Blaha
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
- Silicon Kidney, San Ramon, CA 94583, USA
| | - Lynda A. Frassetto
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
| | - William H. Fissell
- Silicon Kidney, San Ramon, CA 94583, USA
- Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Shant M. Vartanian
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
| | - Shuvo Roy
- Departments of Bioengineering & Therapeutic Sciences, Surgery, Medicine, and Radiology & Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.M.)
- Silicon Kidney, San Ramon, CA 94583, USA
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Kim EJ, Chen C, Gologorsky R, Santandreu A, Torres A, Wright N, Goodin MS, Moyer J, Chui BW, Blaha C, Brakeman P, Vartanian S, Tang Q, David Humes H, Fissell WH, Roy S. Feasibility of an implantable bioreactor for renal cell therapy using silicon nanopore membranes. Nat Commun 2023; 14:4890. [PMID: 37644033 PMCID: PMC10465514 DOI: 10.1038/s41467-023-39888-2] [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] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/03/2023] [Indexed: 08/31/2023] Open
Abstract
The definitive treatment for end-stage renal disease is kidney transplantation, which remains limited by organ availability and post-transplant complications. Alternatively, an implantable bioartificial kidney could address both problems while enhancing the quality and length of patient life. An implantable bioartificial kidney requires a bioreactor containing renal cells to replicate key native cell functions, such as water and solute reabsorption, and metabolic and endocrinologic functions. Here, we report a proof-of-concept implantable bioreactor containing silicon nanopore membranes to offer a level of immunoprotection to human renal epithelial cells. After implantation into pigs without systemic anticoagulation or immunosuppression therapy for 7 days, we show that cells maintain >90% viability and functionality, with normal or elevated transporter gene expression and vitamin D activation. Despite implantation into a xenograft model, we find that cells exhibit minimal damage, and recipient cytokine levels are not suggestive of hyperacute rejection. These initial data confirm the potential feasibility of an implantable bioreactor for renal cell therapy utilizing silicon nanopore membranes.
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Affiliation(s)
- Eun Jung Kim
- University of California, San Francisco, CA, USA
| | - Caressa Chen
- University of California, San Francisco, CA, USA
| | | | | | | | - Nathan Wright
- University of California, San Francisco, CA, USA
- Silicon Kidney LLC, San Ramon, CA, USA
| | | | | | | | - Charles Blaha
- University of California, San Francisco, CA, USA
- Silicon Kidney LLC, San Ramon, CA, USA
| | | | | | - Qizhi Tang
- University of California, San Francisco, CA, USA
| | - H David Humes
- University of Michigan, Ann Arbor, MI, USA
- Innovative Biotherapies Inc, Ann Arbor, MI, USA
| | - William H Fissell
- Silicon Kidney LLC, San Ramon, CA, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shuvo Roy
- University of California, San Francisco, CA, USA.
- Silicon Kidney LLC, San Ramon, CA, USA.
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Santandreu AG, Taheri-Tehrani P, Feinberg B, Torres A, Blaha C, Shaheen R, Moyer J, Wright N, Szot GL, Fissell WH, Vartanian S, Posselt A, Roy S. Characterization of human islet function in a convection-driven intravascular bioartificial pancreas. Bioeng Transl Med 2023; 8:e10444. [PMID: 36925691 PMCID: PMC10013798 DOI: 10.1002/btm2.10444] [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: 05/12/2022] [Revised: 09/13/2022] [Accepted: 10/30/2022] [Indexed: 12/23/2022] Open
Abstract
Clinical islet transplantation for treatment of type 1 diabetes (T1D) is limited by the shortage of pancreas donors and need for lifelong immunosuppressive therapy. A convection-driven intravascular bioartificial pancreas (iBAP) based on highly permeable, yet immunologically protective, silicon nanopore membranes (SNM) holds promise to sustain islet function without the need for immunosuppressants. Here, we investigate short-term functionality of encapsulated human islets in an iBAP prototype. Using the finite element method (FEM), we calculated predicted oxygen profiles within islet scaffolds at normalized perifusion rates of 14-200 nl/min/IEQ. The modeling showed the need for minimum in vitro and in vivo islet perifusion rates of 28 and 100 nl/min/IEQ, respectively to support metabolic insulin production requirements in the iBAP. In vitro glucose-stimulated insulin secretion (GSIS) profiles revealed a first-phase response time of <15 min and comparable insulin production rates to standard perifusion systems (~10 pg/min/IEQ) for perifusion rates of 100-200 nl/min/IEQ. An intravenous glucose tolerance test (IVGTT), performed at a perifusion rate of 100-170 nl/min/IEQ in a non-diabetic pig, demonstrated a clinically relevant C-peptide production rate (1.0-2.8 pg/min/IEQ) with a response time of <5 min.
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Affiliation(s)
- Ana G Santandreu
- Department of Bioengineering and Therapeutic Sciences University of California - San Francisco San Francisco California USA
| | - Parsa Taheri-Tehrani
- Department of Bioengineering and Therapeutic Sciences University of California - San Francisco San Francisco California USA
| | - Benjamin Feinberg
- Department of Bioengineering and Therapeutic Sciences University of California - San Francisco San Francisco California USA
| | - Alonso Torres
- Department of Bioengineering and Therapeutic Sciences University of California - San Francisco San Francisco California USA
| | - Charles Blaha
- Department of Bioengineering and Therapeutic Sciences University of California - San Francisco San Francisco California USA.,Silicon Kidney LLC San Francisco California USA
| | - Rebecca Shaheen
- Department of Bioengineering and Therapeutic Sciences University of California - San Francisco San Francisco California USA
| | - Jarrett Moyer
- Department of Surgery University of California - San Francisco San Francisco California USA
| | - Nathan Wright
- Department of Bioengineering and Therapeutic Sciences University of California - San Francisco San Francisco California USA.,Silicon Kidney LLC San Francisco California USA
| | - Gregory L Szot
- Department of Surgery University of California - San Francisco San Francisco California USA
| | - William H Fissell
- Silicon Kidney LLC San Francisco California USA.,Division of Nephrology and Hypertension Vanderbilt University Medical Center Nashville Tennessee USA
| | - Shant Vartanian
- Department of Surgery University of California - San Francisco San Francisco California USA
| | - Andrew Posselt
- Department of Surgery University of California - San Francisco San Francisco California USA
| | - Shuvo Roy
- Department of Bioengineering and Therapeutic Sciences University of California - San Francisco San Francisco California USA.,Silicon Kidney LLC San Francisco California USA
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Moyer J, Dunj. Baston-Buest D, Wennemuth G, Bielfeld A, Grümmer R. P–322 Addressing progesterone and cAMP signalling pathways for decidualization induction of endometrial stromal cells of patients with endometriosis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Which compounds/compound combinations are most effective in decidualization induction of endometrial stromal cells (ESCs) of patients with and without endometriosis?
Summary answer
Combination of compounds addressing different steps in the signalling cascade of decidualization induce decidualization more effectively than application of the individual compounds alone.
What is known already
Decidualization is the monthly recurring differentiation process of the ESCs in preparation for embryo implantation in human. Undifferentiated ESCs reveal an increased potential to proliferate and invade after retrograde menstruation. This may lead to the formation of ectopic lesions and the manifestation of the chronic gynaecological disease of endometriosis due to an impairment of the decidualization process.
Study design, size, duration
Compounds and compound combinations addressing the progesterone receptor- or the cAMP-mediated pathway were evaluated with regard to their own and their synergistic potential to induce decidualization of ESCs from women with (n = 10) and without (n = 10) endometriosis during a 6-day treatment.
Participants/materials, setting, methods
Human primary ESCs were isolated via enzymatic-mechanic digestion from eutopic endometrium from women with and without endometriosis and treated for 6 days in vitro with different progestins (progesterone, medoxyprogesterone acetate (MPA)), 8-Br-cAMP, forskolin, or phosphodiesterase (PDE)-inhibitor (Rolipram) alone or in combination. The degree of decidualization induction was quantified by morphological, biochemical (prolactin) and molecular (HAND2, FOXO1) parameters by means of ELISA, flow cytometric analysis, Realtime PCR and Western blot analysis.
Main results and the role of chance
After 6 days of treatment, decidualization was induced by forskolin as well as by 8-Br-cAMP whereas progestins or PDE alone hardly induced prolactin secretion by ESCs as a marker of decidualization. A change of morphology from undifferentiated fibroblast-like cells to rounded cells could be observed in parallel with the secretion of prolactin. Forskolin and 8-Br-cAMP-induced decidualization was significantly enhanced by MPA but not by progesterone. These effects were similar in ESCs from women with and without endometriosis. Moreover, forskolin-induced decidualization was significantly enhanced by simultaneous application of PDE. Interestingly, this effect was higher in cells of patients with endometriosis. An induction of decidualization in ESCs was associated with a parallel increase of the process-associated transcription factors HAND2 and FOXO1. This rise of transcription was markedly increased in combination with MPA but not with progesterone.
Limitations, reasons for caution
Endometrial tissue was obtained from women undergoing infertility treatment and thus may differ from the endometrium of fertile women. Results obtained from primary cells in vitro may not cover the in vivo situation in all respects.
Wider implications of the findings: The results of this study provide baseline data for the development of a possible therapeutical approach to induce decidualization as a treatment option for endometriosis. Further research is required to determine the effectiveness of the in vitro tested compound combinations in an in vivo model.
Trial registration number
Not applicable
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Affiliation(s)
- J Moyer
- University Hospital Essen Germany, Institute of Anatomy, Essen, Germany
| | - D Dunj. Baston-Buest
- Medical Center University of Düsseldorf, Department for OB/GYN and REI UniKiD, Düsseld0rf, Germany
| | - G Wennemuth
- University Hospital Essen Germany, Institute of Anatomy, Essen, Germany
| | - A Bielfeld
- Medical Center University of Düsseldorf, Department for OB/GYN and REI UniKiD, Düsseld0rf, Germany
| | - R Grümmer
- University Hospital Essen Germany, Institute of Anatomy, Essen, Germany
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6
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Moyer J, Dunja Baston-Buest D, Wennemuth G, Bielfeld A, Grümmer R. P-322 Addressing progesterone and cAMP signalling pathways for decidualization induction of endometrial stromal cells of patients with endometriosis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab127.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Which compounds/compound combinations are most effective in decidualization induction of endometrial stromal cells (ESCs) of patients with and without endometriosis?
Summary answer
Combination of compounds addressing different steps in the signalling cascade of decidualization induce decidualization more effectively than application of the individual compounds alone.
What is known already
Decidualization is the monthly recurring differentiation process of the ESCs in preparation for embryo implantation in human. Undifferentiated ESCs reveal an increased potential to proliferate and invade after retrograde menstruation. This may lead to the formation of ectopic lesions and the manifestation of the chronic gynaecological disease of endometriosis due to an impairment of the decidualization process.
Study design, size, duration
Compounds and compound combinations addressing the progesterone receptor- or the cAMP-mediated pathway were evaluated with regard to their own and their synergistic potential to induce decidualization of ESCs from women with (n = 10) and without (n = 10) endometriosis during a 6-day treatment.
Participants/materials, setting, methods
Human primary ESCs were isolated via enzymatic-mechanic digestion from eutopic endometrium from women with and without endometriosis and treated for 6 days in vitro with different progestins (progesterone, medoxyprogesterone acetate (MPA)), 8-Br-cAMP, forskolin, or phosphodiesterase (PDE)-inhibitor (Rolipram) alone or in combination. The degree of decidualization induction was quantified by morphological, biochemical (prolactin) and molecular (HAND2, FOXO1) parameters by means of ELISA, flow cytometric analysis, Realtime PCR and Western blot analysis.
Main results and the role of chance
After 6 days of treatment, decidualization was induced by forskolin as well as by 8-Br-cAMP whereas progestins or PDE alone hardly induced prolactin secretion by ESCs as a marker of decidualization. A change of morphology from undifferentiated fibroblast-like cells to rounded cells could be observed in parallel with the secretion of prolactin. Forskolin and 8-Br-cAMP-induced decidualization was significantly enhanced by MPA but not by progesterone. These effects were similar in ESCs from women with and without endometriosis. Moreover, forskolin-induced decidualization was significantly enhanced by simultaneous application of PDE. Interestingly, this effect was higher in cells of patients with endometriosis. An induction of decidualization in ESCs was associated with a parallel increase of the process-associated transcription factors HAND2 and FOXO1. This rise of transcription was markedly increased in combination with MPA but not with progesterone.
Limitations, reasons for caution
Endometrial tissue was obtained from women undergoing infertility treatment and thus may differ from the endometrium of fertile women. Results obtained from primary cells in vitro may not cover the in vivo situation in all respects.
Wider implications of the findings
The results of this study provide baseline data for the development of a possible therapeutical approach to induce decidualization as a treatment option for endometriosis. Further research is required to determine the effectiveness of the in vitro tested compound combinations in an in vivo model.
Trial registration number
not applicable
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Affiliation(s)
- J Moyer
- University Hospital Essen Germany, Institute of Anatomy, Essen, Germany
| | - D Dunja Baston-Buest
- Medical Center University of Düsseldorf, Department for OB/GYN and REI UniKiD, Düsseld0rf, Germany
| | - G Wennemuth
- University Hospital Essen Germany, Institute of Anatomy, Essen, Germany
| | - A Bielfeld
- Medical Center University of Düsseldorf, Department for OB/GYN and REI UniKiD, Düsseld0rf, Germany
| | - R Grümmer
- University Hospital Essen Germany, Institute of Anatomy, Essen, Germany
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Graves CE, Moyer J, Zobel MJ, Mora R, Smith D, O'Day M, Padilla BE. Intraoperative intercostal nerve cryoablation During the Nuss procedure reduces length of stay and opioid requirement: A randomized clinical trial. J Pediatr Surg 2019; 54:2250-2256. [PMID: 30935731 PMCID: PMC6920013 DOI: 10.1016/j.jpedsurg.2019.02.057] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [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: 11/07/2018] [Revised: 01/29/2019] [Accepted: 02/22/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Minimally-invasive repair of pectus excavatum by the Nuss procedure is associated with significant postoperative pain, prolonged hospital stay, and high opiate requirement. We hypothesized that intercostal nerve cryoablation during the Nuss procedure reduces hospital length of stay (LOS) compared to thoracic epidural analgesia. DESIGN This randomized clinical trial evaluated 20 consecutive patients undergoing the Nuss procedure for pectus excavatum between May 2016 and March 2018. Patients were randomized evenly via closed-envelope method to receive either cryoanalgesia or thoracic epidural analgesia. Patients and physicians were blinded to study arm until immediately preoperatively. SETTING Single institution, UCSF-Benioff Children's Hospital. PARTICIPANTS 20 consecutive patients were recruited from those scheduled for the Nuss procedure. Exclusion criteria were age < 13 years, chest wall anomaly other than pectus excavatum, previous repair or other thoracic surgery, and chronic use of pain medications. MAIN OUTCOMES AND MEASURES Primary outcome was postoperative LOS. Secondary outcomes included total operative time, total/daily opioid requirement, inpatient/outpatient pain score, and complications. Primary outcome data were analyzed by the Mann-Whitney U-test for nonparametric continuous variables. Other continuous variables were analyzed by two-tailed t-test, while categorical data were compared via Chi-squared test, with alpha = 0.05 for significance. RESULTS 20 patients were randomized to receive either cryoablation (n = 10) or thoracic epidural (n = 10). Mean operating room time was 46.5 min longer in the cryoanalgesia group (p = 0.0001). Median LOS decreased by 2 days in patients undergoing cryoablation, to 3 days from 5 days (Mann-Whitney U, p = 0.0001). Cryoablation patients required significantly less inpatient opioid analgesia with a mean decrease of 416 mg oral morphine equivalent per patient (p = 0.0001), requiring 52%-82% fewer milligrams on postoperative days 1-3 (p < 0.01 each day). There was no difference in mean pain score between the groups at any point postoperatively, up to one year, and no increased incidence of neuropathic pain in the cryoablation group. No complications were noted in the cryoablation group; among patients with epidurals, one patient experienced a symptomatic pneumothorax and another had urinary retention. CONCLUSIONS AND RELEVANCE Intercostal nerve cryoablation during the Nuss procedure decreases hospital length of stay and opiate requirement versus thoracic epidural analgesia, while offering equivalent pain control. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | | | | | | | | | | | - Benjamin E. Padilla
- Corresponding author at: University of California, San Francisco Department of Surgery Division of Pediatric Surgery 550 16th St, Fifth Floor San Francisco, CA 94158-0570 United States. (B.E. Padilla)
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Iqbal Z, Kim S, Moyer J, Moses W, Abada E, Wright N, Kim EJ, Park J, Fissell WH, Vartanian S, Roy S. In vitro and in vivo hemocompatibility assessment of ultrathin sulfobetaine polymer coatings for silicon-based implants. J Biomater Appl 2019; 34:297-312. [PMID: 30862226 DOI: 10.1177/0885328219831044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Zohora Iqbal
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Steven Kim
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Jarrett Moyer
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Willieford Moses
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Emily Abada
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Nathan Wright
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Eun Jung Kim
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Jaehyun Park
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | | | - Shant Vartanian
- 3 Division of Vascular & Endovascular Surgery, University of California, San Francisco, USA
| | - Shuvo Roy
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
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Buck AKW, Goebel SG, Goodin MS, Wright NJ, Groszek JJ, Moyer J, Singh S, Bluestein D, Fissell WH, Roy S. Original article submission: Platelet stress accumulation analysis to predict thrombogenicity of an artificial kidney. J Biomech 2018; 69:26-33. [PMID: 29395231 DOI: 10.1016/j.jbiomech.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/27/2017] [Accepted: 01/08/2018] [Indexed: 02/01/2023]
Abstract
An implantable artificial kidney using a hemofilter constructed from an array of silicon membranes to provide ultrafiltration requires a suitable blood flow path to ensure stable operation in vivo. Two types of flow paths distributing blood to the array of membranes were evaluated: parallel and serpentine. Computational fluid dynamics (CFD) simulations were used to guide the development of the blood flow paths. Pressure data from animal tests were used to obtain pulsatile flow conditions imposed in the transient simulations. A key consideration for stable operation in vivo is limiting platelet stress accumulation to avoid platelet activation and thrombus formation. Platelet stress exposure was evaluated by CFD particle tracking methods through the devices to provide distributions of platelet stress accumulation. The distributions of stress accumulation over the duration of a platelet lifetime for each device revealed that stress accumulation for the serpentine flow path exceeded levels expected to cause platelet activation while the accumulated stress for the parallel flow path was below expected activation levels.
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Affiliation(s)
- Amanda K W Buck
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | | | | | - Nathan J Wright
- Department of Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Joseph J Groszek
- Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jarrett Moyer
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sukhveer Singh
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - William H Fissell
- Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shuvo Roy
- Department of Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA.
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Abstract
Congenital lung lesions (CLLs) comprise a heterogeneous group of developmental and histologic entities often diagnosed on screening prenatal ultrasound. Most fetuses with CLL are asymptomatic at birth; however, the risk of malignancy and infection drives the decision to prophylactically resect these lesions. The authors describe their approach to minimally invasive lobectomy in children with CLLs, postoperative care, and management of procedure-specific complications.
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Affiliation(s)
- Jarrett Moyer
- Department of Surgery, University of CA - San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA 94143, USA.
| | - Hanmin Lee
- Professor of Surgery, Division of Pediatric Surgery, Dept of Surgery, Universty of CA - San Francisco, San Francisco, CA
| | - Lan Vu
- Assistant Professor of Surgery, Division of Pediatric Surgery, Dept of Surgery, University of CA - San Francisco, San Francisco, CA
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Swiecicki P, Dickerson E, Srinivasan A, Zhao L, Bellile E, Sacco A, Chepeha D, Dobrosotskaya I, Spector M, Shuman A, Malloy K, Moyer J, McKean E, Wolf G, Eisbruch A, Prince M, Bradford C, Carey T, Worden F. A Phase 2 Study Evaluating Axitinib in Patients With Unresectable, Recurrent, or Metastatic Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Moyer J, Vickery T. Interference from an integral feature in visual statistical summary representations. J Vis 2014. [DOI: 10.1167/14.10.1054] [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: 11/24/2022] Open
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13
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Moyer J, Palomares M. Enumeration performance modulated by spatial working memory load. J Vis 2013. [DOI: 10.1167/13.9.1354] [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: 11/24/2022] Open
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14
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Moyer J, Payne A, Pitts CH, Palomares M. Does variability affect statistical averaging of length and orientation? J Vis 2012. [DOI: 10.1167/12.9.351] [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: 11/24/2022] Open
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15
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Porcar L, Pozzo D, Langenbucher G, Moyer J, Butler PD. Rheo-small-angle neutron scattering at the National Institute of Standards and Technology Center for Neutron Research. Rev Sci Instrum 2011; 82:083902. [PMID: 21895253 DOI: 10.1063/1.3609863] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We describe the design and operation of a modified commercial rheometer to simultaneously perform rheological measurements and structural studies by small angle neutron scattering (SANS). The apparatus uses a Couette geometry shear cell allowing two of the three scattering planes to be observed by performing experiments in either the radial or tangential geometries. The device enables small angle neutron scattering patterns to be obtained simultaneously with a wide variety of rheological measurements such as stress/strain flow curves, oscillatory deformations, and creep, recovery and relaxation tests, from -20 °C to 150 °C, for samples with viscosities varying by several orders of magnitude. We give a brief report of recent experiments performed on a dispersion of acicular nanoparticles and biopolymer network under stress demonstrating the utility of such measurements. This device has been developed at the National Institute of Standards and Technology's Center for Neutron Research (NCNR) and made available to the complex fluids community as part of the standard sample environment equipment.
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Affiliation(s)
- L Porcar
- National Institute of Standards and Technology, Center for Neutron Research, Gaithersburg, Maryland 20899, USA
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16
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Dobrosotskaya IY, Light E, Maxwell JM, Byrd SA, Spector ME, Kumar B, Feng FY, Eisbruch A, Wolf GT, Prince M, Moyer J, Teknos TN, Chepeha DB, Walline HM, McHugh JB, Cordell KG, Urba S, Bradford CR, Carey T, Worden FP. Chemoselection with induction chemotherapy followed by chemoradiation or surgery versus chemoradiation for patients (pts) with locally advanced squamous cell carcinoma of the oropharynx (LASCCOP). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Hadjiiski L, Mukherji SK, Gujar SK, Sahiner B, Ibrahim M, Street E, Moyer J, Worden FP, Chan HP. Treatment response assessment of head and neck cancers on CT using computerized volume analysis. AJNR Am J Neuroradiol 2010; 31:1744-51. [PMID: 20595363 DOI: 10.3174/ajnr.a2177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Head and neck cancer can cause substantial morbidity and mortality. Our aim was to evaluate the potential usefulness of a computerized system for segmenting lesions in head and neck CT scans and for estimation of volume change of head and neck malignant tumors in response to treatment. MATERIALS AND METHODS CT scans from a pretreatment examination and a post 1-cycle chemotherapy examination of 34 patients with 34 head and neck primary-site cancers were collected. The computerized system was developed in our laboratory. It performs 3D segmentation on the basis of a level-set model and uses as input an approximate bounding box for the lesion of interest. The 34 tumors included tongue, tonsil, vallecula, supraglottic, epiglottic, and hard palate carcinomas. As a reference standard, 1 radiologist outlined full 3D contours for each of the 34 primary tumors for both the pre- and posttreatment scans and a second radiologist verified the contours. RESULTS The correlation between the automatic and manual estimates for both the pre- to post-treatment volume change and the percentage volume change for the 34 primary-site tumors was 0.95, with an average error of -2.4 ± 8.5% by automatic segmentation. There was no substantial difference and specific trend in the automatic segmentation accuracy for the different types of primary head and neck tumors, indicating that the computerized segmentation performs relatively robustly for this application. CONCLUSIONS The tumor size change in response to treatment can be accurately estimated by the computerized segmentation system relative to radiologists' manual estimations for different types of head and neck tumors.
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Affiliation(s)
- L Hadjiiski
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5842, USA.
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18
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Worden FP, Wolf GT, Lee J, Bradford CR, Chepeha DB, Prince M, Eisbruch A, Moyer J, Urba S, Carey T. Outcomes related to biomarkers in organ preservation for patients with advanced squamous cell carcinoma of the oral cavity (SCCOC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Worden FP, Hooton J, Lee J, Eisbruch A, Wolf GT, Prince M, Moyer J, Teknos T, Chepeha DB, Bradford CR, Carey T. Association of tobacco (T) use with risk of distant metastases (DM), tumor recurrence, and death in patients (pts) with HPV-positive (+) squamous cell cancer of the oropharynx (SCCOP). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6001 Background: Chemoradiation (CRT) for HPV (+) SCCOP is associated with a more favorable prognosis than HPV-negative (-) SCCOP. However, the interaction of HPV and T in terms of etiology and disease progression remains unclear. HPV (+) SCCOP pts were prospectively studied to determine if T use was a key variable in discriminating which pts would develop DM, locoregional recurrences (LR), or second primaries (SP). Methods: From 1999–2007, 124 pts with stage III/IV SCCOP were enrolled in one of two CRT trials. Tumor specimens were analyzed for HPV presence and type. Use of T, determined via self-reporting and chart review, was recorded as both continuous (number of pack-yrs) and categorical (never, former, and current) variables. Former T users were subdivided into an early cessation group (quit ≥ 20 yrs prior to diagnosis) and a late cessation group (quit < 20 yrs prior to diagnosis). T use and HPV status were analyzed with respect to survival & the development of DM, LR, or SP. Results: Of the 124 pts, 100 (81%) were HPV (+), 22 of which developed disease progression (22%). Twenty-four were HPV (-), 12 of which had disease progression (50%). Seventeen of 124 pts (14%) developed DM [12 HPV (+), 5 HPV (-)]. Nine of 124 (7%) developed LR [5 HPV (+), 4 HPV (-)], and 8 of 124 (7%) developed SP [5 HPV (+), 3 HPV (-)]. Thirty-two HPV (+) pts were never-T users, 88% (28/32) of which remain alive with no evidence of disease; 3 died from other causes and 1 died of lung metastases from SCCOP. Sixty-eight were HPV (+) and had T exposure. Of 46 former T users, 37/46 (80%) are living. Twenty were HPV (+) and in the early cessation group, 35% (7/20) of which had disease progression [3 LR, 3 DM, 1 SP]. Twenty-six HPV (+) pts were former T users in the late cessation group, 11% (3/26) of which had disease progression [2 DM, 1 SP]. Of 22 HPV (+) current T users, 68% (15/22) are alive and 36% (8/22) have developed disease progression. Seventeen of the 24 HPV (-) pts were current T users, 47% (8/17) of which developed disease progression. Conclusions: Never-T users with HPV-positive SCCOP have improved survival & reduced risk of disease progression compared to HPV (+) & HPV (-) former & current T users. No significant financial relationships to disclose.
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Affiliation(s)
- F. P. Worden
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - J. Hooton
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - J. Lee
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - A. Eisbruch
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - G. T. Wolf
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - M. Prince
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - J. Moyer
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - T. Teknos
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - D. B. Chepeha
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - C. R. Bradford
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
| | - T. Carey
- University of Michigan, Ann Arbor, MI; Ohio State University, Columbus, OH
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20
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Solter D, Hiiragi T, Evsikov AV, Moyer J, De Vries WN, Peaston AE, Knowles BB. Epigenetic mechanisms in early mammalian development. Cold Spring Harb Symp Quant Biol 2004; 69:11-7. [PMID: 16117628 DOI: 10.1101/sqb.2004.69.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- D Solter
- Max-Planck Institute of Immunobiology, 79108 Freiburg, Germany
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21
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Woo MK, Lee A, Fischer RS, Moyer J, Fowler VM. The lens membrane skeleton contains structures preferentially enriched in spectrin-actin or tropomodulin-actin complexes. Cell Motil Cytoskeleton 2000; 46:257-68. [PMID: 10962480 DOI: 10.1002/1097-0169(200008)46:4<257::aid-cm3>3.0.co;2-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The spectrin-based membrane skeleton plays an important role in determining the distributions and densities of receptors, ion channels, and pumps, thus influencing cell shape and deformability, cell polarity, and adhesion. In the paradigmatic human erythrocyte, short tropomodulin-capped actin filaments are cross-linked by spectrin into a hexagonal network, yet the extent to which this type of actin filament organization is utilized in the membrane skeletons of nonerythroid cells is not known. Here, we show that associations of tropomodulin and spectrin with actin in bovine lens fiber cells are distinct from that of the erythrocyte and imply a very different molecular organization. Mechanical disruption of the lens fiber cell membrane skeleton releases tropomodulin and actin-containing oligomeric complexes that can be isolated by gel filtration column chromatography, sucrose gradient centrifugation and immunoadsorption. These tropomodulin-actin complexes do not contain spectrin. Instead, spectrin is associated with actin in different complexes that do not contain tropomodulin. Immunofluorescence staining of isolated fiber cells further demonstrates that tropomodulin does not precisely colocalize with spectrin along the lateral membranes of lens fiber cells. Taken together, our data suggest that tropomodulin-capped actin filaments and spectrin-cross-linked actin filaments are assembled in distinct structures in the lens fiber cell membrane skeleton, indicating that it is organized quite differently from that of the erythrocyte membrane skeleton.
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Affiliation(s)
- M K Woo
- Department of Cell Biology, The Scripps Research Institute, La Jolla, California 92037, USA
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22
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Jahn M, Paran I, Hoffmann K, Radwanski ER, Livingstone KD, Grube RC, Aftergoot E, Lapidot M, Moyer J. Genetic mapping of the Tsw locus for resistance to the Tospovirus Tomato spotted wilt virus in Capsicum spp. and its relationship to the Sw-5 gene for resistance to the same pathogen in tomato. Mol Plant Microbe Interact 2000; 13:673-682. [PMID: 10830267 DOI: 10.1094/mpmi.2000.13.6.673] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The Tsw gene conferring dominant resistance to the Tospovirus Tomato spotted wilt virus (TSWV) in Capsicum spp. has been tagged with a random amplified polymorphic DNA marker and mapped to the distal portion of chromosome 10. No mapped homologues of Sw-5, a phenotypically similar dominant TSWV resistance gene in tomato, map to this region in C. annuum, although a number of Sw-5 homologues are found at corresponding positions in pepper and tomato. The relationship between Tsw and Sw-5 was also examined through genetic studies of TSWV. The capacity of TSWV-A to overcome the Tsw gene in pepper and the Sw-5 gene in tomato maps to different TSWV genome segments. Therefore, despite phenotypic and genetic similarities of resistance in tomato and pepper, we infer that distinct viral gene products control the outcome of infection in plants carrying Sw-5 and Tsw, and that these loci do not appear to share a recent common evolutionary ancestor.
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Affiliation(s)
- M Jahn
- Department of Plant Breeding, Cornell University, Ithaca, NY 14853, USA
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23
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Stone D, Imbeau S, Moyer J. Current concepts in allergen immunotherapy. J S C Med Assoc 2000; 96:218-20. [PMID: 10850024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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24
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Louis J, Moyer J, Angelini J, Kagan SH. Metronidazole oral rinse helps to alleviate odor associated with oral lesions. Oncol Nurs Forum 1997; 24:1331. [PMID: 9380587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J Louis
- Hospital of the University of Pennsylvania, Philadelphia, USA
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25
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Krupnick JL, Sotsky SM, Simmens S, Moyer J, Elkin I, Watkins J, Pilkonis PA. The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol 1996. [PMID: 8698947 DOI: 10.1037//0022-006x.64.3.532] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The relationship between therapeutic alliance and treatment outcome was examined for depressed outpatients who received interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Clinical raters scored videotapes of early, middle, and late therapy sessions for 225 cases (619 sessions). Outcome was assessed from patients' and clinical evaluators' perspectives and from depressive symptomatology. Therapeutic alliance was found to have a significant effect on clinical outcome for both psychotherapies and for active and placebo pharmacotherapy. Ratings of patient contribution to the alliance were significantly related to treatment outcome; ratings of therapist contribution to the alliance and outcome were not significantly linked. These results indicate that the therapeutic alliance is a common factor with significant influence on outcome.
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Affiliation(s)
- J L Krupnick
- Department of Psychiatry, Georgetown, University Medical Center, Washington, DC 20007, USA
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26
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Krupnick JL, Sotsky SM, Simmens S, Moyer J, Elkin I, Watkins J, Pilkonis PA. The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol 1996; 64:532-9. [PMID: 8698947 DOI: 10.1037/0022-006x.64.3.532] [Citation(s) in RCA: 371] [Impact Index Per Article: 13.3] [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: 02/01/2023]
Abstract
The relationship between therapeutic alliance and treatment outcome was examined for depressed outpatients who received interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Clinical raters scored videotapes of early, middle, and late therapy sessions for 225 cases (619 sessions). Outcome was assessed from patients' and clinical evaluators' perspectives and from depressive symptomatology. Therapeutic alliance was found to have a significant effect on clinical outcome for both psychotherapies and for active and placebo pharmacotherapy. Ratings of patient contribution to the alliance were significantly related to treatment outcome; ratings of therapist contribution to the alliance and outcome were not significantly linked. These results indicate that the therapeutic alliance is a common factor with significant influence on outcome.
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Affiliation(s)
- J L Krupnick
- Department of Psychiatry, Georgetown, University Medical Center, Washington, DC 20007, USA
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27
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Chavany C, Mimnaugh E, Miller P, Bitton R, Nguyen P, Trepel J, Whitesell L, Schnur R, Moyer J, Neckers L. p185erbB2 binds to GRP94 in vivo. Dissociation of the p185erbB2/GRP94 heterocomplex by benzoquinone ansamycins precedes depletion of p185erbB2. J Biol Chem 1996; 271:4974-7. [PMID: 8617772 DOI: 10.1074/jbc.271.9.4974] [Citation(s) in RCA: 202] [Impact Index Per Article: 7.2] [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: 01/31/2023] Open
Abstract
Treatment of SKBr3 cells with benzoquinone ansamycins, such as geldanamycin (GA), depletes p185erbB2, the receptor tyrosine kinase encoded by the erbB2 gene. In the same cells, a biologically active benzoquinone photoaffinity label specifically binds a protein of about 100 kDa, and the ability of various GA derivatives to reduce the intracellular level of p185erbB2 correlates with their ability to compete with the photoaffinity label for binding to this protein. In this report, we present evidence that the approximately 100-kDa ansamycin-binding protein is GRP94. Membrane-associated p185erbB2 exists in a stable complex with GRP94. GA binding to GRP94 disrupts this complex, leading to degradation of pre-existing p185erbB2 protein, and resulting in an altered subcellular distribution of newly synthesized p185erbB2.
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Affiliation(s)
- C Chavany
- Clinical Pharmacology Branch and Medicine Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Abstract
Previous work has suggested possible influences of ovarian hormones on evoked potentials in the auditory system. The aim of this project was to study the effects of ovariectomy and subsequent administration of estrogen replacement on the auditory brainstem response and the middle latency response. Groups of 90 day-old Long-Evans hooded rats were anesthetized for bilateral ovariectomies (ovex) and recordings made 3 weeks later. During the week prior to recordings some ovariectomized groups received subcutaneous injections of 10, 100 or 500 micrograms/kg Premarin in peanut oil, and other unoperated animals received vehicle injections. Recordings from vertex/chin using needle electrodes and pure tone stimulus parameters were made under Rompun/Ketamine. The results using 40 kHz tone stimuli showed that mean latencies for ovex animals were longer than animals in the 100 micrograms/kg Premarin group for waves 1a, 1an, 1b, 11, 111, 111n, and 1V/V. Other posthoc comparisons at 40 kHz stimulation revealed differences between control and 100 micrograms/kg Premarin groups for latencies of waves 1b, 1bn, 11 and 111. Latency reduction appeared for waves 1b, 1bn, 11 and 111 for the 10 ovex group, but only at wave 11 for the 500 ovex group, compared to ovex-only animals. Data from 8 kHz stimulation also demonstrated significant differences between the ovex and ovex 100 groups at waves 1bn and Vn. Observations of interpeak latency differences, especially between waves 1a and 11, suggested central as well as cochlear involvement in hormone action.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J R Coleman
- Department of Psychology, University of South Carolina, Columbia 29208-0182
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29
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Moyer J. Deciding to rent or buy subacute equipment. Contemp Longterm Care 1994; 17:86. [PMID: 10135864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- J Moyer
- MEDIQ Consulting Group, Pennsauken, NJ
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30
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Brown LS, Phillips RY, Brown CL, Knowlan D, Castle L, Moyer J. HIV/AIDS policies and sports: the National Football League. Med Sci Sports Exerc 1994; 26:403-7. [PMID: 8201893] [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: 01/29/2023]
Abstract
With the assistance of highly respected experts in the field of HIV/AIDS, the NFL has developed a comprehensive policy that should decrease the spread of HIV and any other blood-borne pathogens among its players and medical staff. Transmission of HIV infection is likely to be rare in the NFL. This is supported by the fact that in over 10 yr of the AIDS epidemic, the CDC has not attributed one AIDS case to athletic competition. Whatever the rate of HIV infection, on-the-field transmission is certainly less frequent than hepatitis B, which is manyfold more transmissible than HIV. Based on these facts, a player with HIV infection poses virtually no threat to others or himself by further athletic participation in the NFL. In addition, the relatively short average playing career of an NFL player and the extended period between HIV contraction and development of AIDS symptoms decrease the prospect that a player's HIV-positive status would affect his athletic performance. Consequently, HIV testing should remain voluntary, and continued participation in the NFL of HIV-infected players should remain a private decision between the player and his physician.
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Affiliation(s)
- L S Brown
- Department of Medicine, Harlem Hospital/College of Physicians and Surgeons, Columbia University, New York, NY
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31
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Berger S, Moyer J. Launching a performance-based pay plan. Mod Healthc 1991; 21:64. [PMID: 10112386] [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: 02/11/2023]
Abstract
Performance-based compensation is increasingly replacing the annual bonus as hospitals seek ways to motivate their management. Two Ernst & Young authorities outline how to establish the incentive approach and put the performance measures in place. In the process, the performance goals should communicate what's important to the organization.
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Sotsky SM, Glass DR, Shea MT, Pilkonis PA, Collins JF, Elkin I, Watkins JT, Imber SD, Leber WR, Moyer J. Patient predictors of response to psychotherapy and pharmacotherapy: findings in the NIMH Treatment of Depression Collaborative Research Program. Am J Psychiatry 1991; 148:997-1008. [PMID: 1853989 DOI: 10.1176/ajp.148.8.997] [Citation(s) in RCA: 349] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The authors investigated patient characteristics predictive of treatment response in the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program. METHOD Two hundred thirty-nine outpatients with major depressive disorder according to the Research Diagnostic Criteria entered a 16-week multicenter clinical trial and were randomly assigned to interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Pretreatment sociodemographic features, diagnosis, course of illness, function, personality, and symptoms were studied to identify patient predictors of depression severity (measured with the Hamilton Rating Scale for Depression) and complete response (measured with the Hamilton scale and the Beck Depression Inventory). RESULTS One hundred sixty-two patients completed the entire 16-week trial. Six patient characteristics, in addition to depression severity previously reported, predicted outcome across all treatments: social dysfunction, cognitive dysfunction, expectation of improvement, endogenous depression, double depression, and duration of current episode. Significant patient predictors of differential treatment outcome were identified. 1) Low social dysfunction predicted superior response to interpersonal psychotherapy. 2) Low cognitive dysfunction predicted superior response to cognitive-behavior therapy and to imipramine. 3) High work dysfunction predicted superior response to imipramine. 4) High depression severity and impairment of function predicted superior response to imipramine and to interpersonal psychotherapy. CONCLUSIONS The results demonstrate the relevance of patient characteristics, including social, cognitive, and work function, for prediction of the outcome of major depressive disorder. They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities, which may be of value in the selection of patients for alternative treatments.
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Affiliation(s)
- S M Sotsky
- Department of Psychiatry and Behavioral Sciences, George Washington University Medical Center, Washington, DC 20037
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Myers TF, Ahmed GS, Anderson CL, Addelson R, Moyer J. A modification of the International Classification of Diseases for Uniform Coding of Diagnosis, Procedures, and Medications. The Perinatal Intensive Care Computer System. Am J Perinatol 1985; 2:240-1. [PMID: 3925961 DOI: 10.1055/s-2007-999959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Moyer J. How well are you paying your executives? Trustee 1982; 35:25-8. [PMID: 10254334] [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: 02/12/2023]
Abstract
A well-designed executive compensation program can help to motivate and retain key executives. An executive compensation program should be linked to the hospital's objectives, should be competitive in the marketplace, should minimize the executive's taxes, and should meet executive expectations.
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