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Ibrahim ESH, Rubenstein J, Sosa A, Stojanovska J, Pan A, North P, Rui H, Benjamin I. Myocardial Strain for the Differentiation of Myocardial Involvement in the Post-Acute Sequelae of COVID-19-A Multiparametric Cardiac MRI Study. Tomography 2024; 10:331-348. [PMID: 38535768 PMCID: PMC10974260 DOI: 10.3390/tomography10030026] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/01/2024] Open
Abstract
Myocardial involvement was shown to be associated with an unfavorable prognosis in patients with COVID-19, which could lead to fatal outcomes as in myocardial injury-induced arrhythmias and sudden cardiac death. We hypothesized that magnetic resonance imaging (MRI) myocardial strain parameters are sensitive markers for identifying subclinical cardiac dysfunction associated with myocardial involvement in the post-acute sequelae of COVID-19 (PASC). This study evaluated 115 subjects, including 65 consecutive COVID-19 patients, using MRI for the assessment of either post-COVID-19 myocarditis or other cardiomyopathies. Subjects were categorized, based on the results of the MRI exams, as having either 'suspected' or 'excluded' myocarditis. A control group of 50 matched individuals was studied. Along with parameters of global cardiac function, the MRI images were analyzed for measurements of the myocardial T1, T2, extracellular volume (ECV), strain, and strain rate. Based on the MRI late gadolinium enhancement and T1/T2/ECV mappings, myocarditis was suspected in 7 out of 22 patients referred due to concern of myocarditis and in 9 out of 43 patients referred due to concern of cardiomyopathies. The myocardial global longitudinal, circumferential, and radial strains and strain rates in the suspected myocarditis group were significantly smaller than those in the excluded myocarditis group, which in turn were significantly smaller than those in the control group. The results showed significant correlations between the strain, strain rate, and global cardiac function parameters. In conclusion, this study emphasizes the value of multiparametric MRI for differentiating patients with myocardial involvement in the PASC based on changes in the myocardial contractility pattern and tissue structure.
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Affiliation(s)
- El-Sayed H. Ibrahim
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Jason Rubenstein
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.R.); (I.B.)
| | - Antonio Sosa
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Jadranka Stojanovska
- Department of Radiology, New York University, 221 Lexington Ave, New York, NY 10016, USA;
| | - Amy Pan
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Paula North
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (P.N.); (H.R.)
| | - Hallgeir Rui
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (P.N.); (H.R.)
| | - Ivor Benjamin
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.R.); (I.B.)
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David KA, Sundaram S, Kim S, Vaca R, Lin Y, Singer S, Malecek M, Carter J, Zayac A, Kim MS, Reddy N, Ney D, Habib A, Strouse C, Graber J, Bachanova V, Salman S, Vendiola JA, Hossain N, Tsang M, Major A, Bond DB, Agrawal P, Mier‐Hicks A, Torka P, Rajakumar P, Venugopal P, Berg S, Glantz M, Goldlust S, Kumar P, Ollila T, Cai J, Spurgeon S, Sieg A, Cleveland J, Epperla N, Karmali R, Naik S, Martin P, Smith SM, Rubenstein J, Kahl B, Evens AM. OLDER PATIENTS WITH PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL): REAL WORLD (RW) OUTCOMES OF POST‐INDUCTION THERAPY IN THE MODERN ERA. Hematol Oncol 2021. [DOI: 10.1002/hon.69_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Brown SA, Zaharova S, Mason P, Thompson J, Thapa B, Ishizawar D, Wilkes E, Ahmed G, Rubenstein J, Sanchez J, Joyce D, Kalyanaraman B, Widlansky M. Pandemic Perspective: Commonalities Between COVID-19 and Cardio-Oncology. Front Cardiovasc Med 2020; 7:568720. [PMID: 33344513 PMCID: PMC7746643 DOI: 10.3389/fcvm.2020.568720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022] Open
Abstract
Overlapping commonalities between coronavirus disease of 2019 (COVID-19) and cardio-oncology regarding cardiovascular toxicities (CVT), pathophysiology, and pharmacology are special topics emerging during the pandemic. In this perspective, we consider an array of CVT common to both COVID-19 and cardio-oncology, including cardiomyopathy, ischemia, conduction abnormalities, myopericarditis, and right ventricular (RV) failure. We also emphasize the higher risk of severe COVID-19 illness in patients with cardiovascular disease (CVD) or its risk factors or cancer. We explore commonalities in the underlying pathophysiology observed in COVID-19 and cardio-oncology, including inflammation, cytokine release, the renin-angiotensin-aldosterone-system, coagulopathy, microthrombosis, and endothelial dysfunction. In addition, we examine common pharmacologic management strategies that have been elucidated for CVT from COVID-19 and various cancer therapies. The use of corticosteroids, as well as antibodies and inhibitors of various molecules mediating inflammation and cytokine release syndrome, are discussed. The impact of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is also addressed, since these drugs are used in cardio-oncology and have received considerable attention during the COVID-19 pandemic, since the culprit virus enters human cells via the angiotensin converting enzyme 2 (ACE2) receptor. There are therefore several areas of overlap, similarity, and interaction in the toxicity, pathophysiology, and pharmacology profiles in COVID-19 and cardio-oncology syndromes. Learning more about either will likely provide some level of insight into both. We discuss each of these topics in this viewpoint, as well as what we foresee as evolving future directions to consider in cardio-oncology during the pandemic and beyond. Finally, we highlight commonalities in health disparities in COVID-19 and cardio-oncology and encourage continued development and implementation of innovative solutions to improve equity in health and healing.
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Affiliation(s)
- Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Svetlana Zaharova
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Peter Mason
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jonathan Thompson
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Bicky Thapa
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David Ishizawar
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Erin Wilkes
- Department of Pharmacy, Froedtert Health and Medical College of Wisconsin, Milwaukee, WI, United States
| | - Gulrayz Ahmed
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jason Rubenstein
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joyce Sanchez
- Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David Joyce
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Michael Widlansky
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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Green R, Rubenstein J, Popoli R, Capulong R, Till C. Sex-specific neurotoxic effects of early-life exposure to fluoride: A review of the epidemiologic and animal literature. CURR EPIDEMIOL REP 2020; 7:263-273. [PMID: 33816056 PMCID: PMC8011433 DOI: 10.1007/s40471-020-00246-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Accepted: 09/21/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW A growing body of evidence suggests adverse neurodevelopmental effects of early-life exposure to fluoride that may differ depending on timing of exposure and sex of the exposed. We conducted a literature search to identify the animal and human epidemiologic studies that examined sex-specific neurodevelopmental differences in response to prenatal and postnatal exposure to fluoride. RECENT FINDINGS Six of 138 animal studies and 15 of 106 human epidemiologic studies tested for sex-specific effects. Prenatal exposure to fluoride was associated with a male susceptibility to adverse behavioural effects in four of six animal studies and lower IQ in one of three prospective cohort studies. The body of evidence examining sex-effects associated with postnatal fluoride exposure was scarce, and many animal and cross-sectional human studies were considered to have a high risk of bias. SUMMARY Compared to females, male offspring appear to be more sensitive to prenatal, but not postnatal, exposure to fluoride. We discuss several sex-specific mechanisms and emphasize the need for future research.
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Affiliation(s)
- R. Green
- York University, Department of Psychology, 4700 Keele St
| | - J. Rubenstein
- York University, Department of Psychology, 4700 Keele St
| | - R. Popoli
- York University, Department of Psychology, 4700 Keele St
| | - R. Capulong
- York University, Department of Psychology, 4700 Keele St
| | - C. Till
- York University, Department of Psychology, 4700 Keele St
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Zysman M, Rubenstein J, Le Guillou F, Colson RMH, Pochulu C, Grassion L, Escamilla R, Piperno D, Pon J, Khan S, Raherison-Semjen C. COPD burden on sexual well-being. Respir Res 2020; 21:311. [PMID: 33238993 PMCID: PMC7687801 DOI: 10.1186/s12931-020-01572-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/12/2020] [Indexed: 12/28/2022] Open
Abstract
Background Sexual function is often affected in patients suffering from chronic diseases especially chronic obstructive pulmonary disease (COPD). However, the effect of COPD on sexual satisfaction is underappreciated in clinical practice. The aim of this study is to evaluate the impact of COPD on patient’s sexuality and the explanatory variables of sexual dissatisfaction. Methods Questionnaires were emailed to participants and they submitted their responses on the Santé Respiratoire France website. Data about sexual well-being (Arizona Sexual Experience Scale, ASEX), Quality of life (VQ11), anxiety, depression (Hospitalized anxiety and depression, HAD) and self-declared COPD grade were collected. Results Seven hundred and fifty one subjects were included and were characterized as follows: women—51%, mean age—61 years, in a couple—62% and 70%—retired. Every grade of COPD was represented. Out of 751 participants, 301 participants (40%) had no sexual activity and 450 (60%) had sexual activity. From the 450 participants, 60% needed to change their sexual life because of their disease (rhythm, frequency and position). Subjects often used medications to improve sexual performance (43% used short-acting bronchodilator and 13% -specific erectile dysfunction drugs). ASEX questionnaire confirmed patients’ dissatisfaction (diminution of sexual appetite for 68% and sexual desire for 60%) because of breathlessness and fatigue. Eighty one percent of the responders had an altered quality of life (VQ11 mean score 35) and frequent suspected anxiety or depression (HAD mean score 10.8). Ninety percent declared that sexual dysfunction had never been discussed by their doctors, while 36% of patients would have preferred to undergo a specialized consultation. Conclusion Sexual dysfunction is frequent among COPD patients and leads to an altered well-being, however being a cultural taboo, it remains frequently neglected. Sexual guidance should be a part of patient’s consultations improve quality of sexual life.
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Affiliation(s)
- M Zysman
- Univ-Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, 33604, Pessac, France. .,Service Des Maladies Respiratoires, Hôpital Haut-Lévèque CHU Bordeaux, 33604, Pessac, France.
| | - J Rubenstein
- Service Des Maladies Respiratoires, Hôpital Haut-Lévèque CHU Bordeaux, 33604, Pessac, France
| | - F Le Guillou
- Santé Respiratoire France, 115 rue Saint Dominique, 75007, Paris, France
| | - R M H Colson
- L'Association Interdisciplinaire Post Universitaire de Sexologie, Toulouse, France
| | - C Pochulu
- Santé Respiratoire France, 115 rue Saint Dominique, 75007, Paris, France
| | - L Grassion
- Service Des Maladies Respiratoires, Hôpital Haut-Lévèque CHU Bordeaux, 33604, Pessac, France
| | - R Escamilla
- Service de Pneumologie CHU Toulouse, Toulouse, France
| | - D Piperno
- Santé Respiratoire France, 115 rue Saint Dominique, 75007, Paris, France
| | - J Pon
- Service de Psychiatrie CHU Toulouse, Toulouse, France
| | - S Khan
- U1219 Inserm, ISPED, University of Bordeaux, Bordeaux, France
| | - C Raherison-Semjen
- Service Des Maladies Respiratoires, CHU Bordeaux, Université de Bordeaux, U1219, EpiceneBordeaux, France
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Bergom C, Rubenstein J, Wilson JF, Welsh A, Ibrahim ESH, Prior P, Schottstaedt AM, Eastwood D, Zhang MJ, Currey A, Puckett L, Strande JL, Bradley JA, White J. A Pilot Study of Cardiac MRI in Breast Cancer Survivors After Cardiotoxic Chemotherapy and Three-Dimensional Conformal Radiotherapy. Front Oncol 2020; 10:506739. [PMID: 33178571 PMCID: PMC7596658 DOI: 10.3389/fonc.2020.506739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE/OBJECTIVES Node-positive breast cancer patients often receive chemotherapy and regional nodal irradiation. The cardiotoxic effects of these treatments, however, may offset some of the survival benefit. Cardiac magnetic resonance (CMR) is an emerging modality to assess cardiac injury. This is a pilot trial assessing cardiac damage using CMR in patients who received anthracycline-based chemotherapy and three-dimensional conformal radiotherapy (3DCRT) regional nodal irradiation using heart constraints. MATERIALS AND METHODS Node-positive breast cancer patients (2000-2008) treated with anthracycline-based chemotherapy and 3DCRT regional nodal irradiation (including the internal mammary chain nodes) with heart ventricular constraints (V25 < 10%) were invited to participate. Cardiac tissues were contoured and analyzed separately for whole heart (pericardium) and for combined ventricles and left atrium (myocardium). CMR obtained ventricular function/dimensions, late gadolinium enhancement (LGE), global longitudinal strain (GLS), and extracellular volume fraction (ECV) as measures of cardiac injury and/or early fibrosis. CMR parameters were correlated with dose-volume constraints using Spearman correlations. RESULTS Fifteen left-sided and five right-sided patients underwent CMR. Median diagnosis age was 50 (32-77). No patients had baseline cardiac disease before regional nodal irradiation. Median time after 3DCRT was 8.3 years (5.2-14.4). Median left-sided mean heart dose (MHD) was 4.8 Gy (1.1-11.2) and V25 was 5.7% (0-12%). Median left ventricular ejection fraction (LVEF) was 63%. No abnormal LGE was observed. No correlations were seen between whole heart doses and LVEF, LV mass, GLS, or LV dimensions. Increasing ECV did not correlate with increased heart or ventricular doses. However, correlations between higher LV mass and ventricular mean dose, V10, and V25 were seen. CONCLUSION At a median follow-up of 8.3 years, this cohort of node-positive breast cancer patients who received anthracycline-based chemotherapy and regional nodal irradiation had no clinically abnormal CMR findings. However, correlations between ventricular mean dose, V10, and V25 and LV mass were seen. Larger corroborating studies that include advanced techniques for measuring regional heart mechanics are warranted.
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Affiliation(s)
- Carmen Bergom
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jason Rubenstein
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - J. Frank Wilson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Aimee Welsh
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - El-Sayed H. Ibrahim
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Phillip Prior
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Daniel Eastwood
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mei-Jie Zhang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Adam Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Lindsay Puckett
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jennifer L. Strande
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Julie A. Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Julia White
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
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Ibrahim ESH, Baruah D, Budde M, Rubenstein J, Frei A, Schlaak R, Gore E, Bergom C. Optimized cardiac functional MRI of small-animal models of cancer radiation therapy. Magn Reson Imaging 2020; 73:130-137. [PMID: 32866598 DOI: 10.1016/j.mri.2020.08.020] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/23/2020] [Accepted: 08/20/2020] [Indexed: 01/27/2023]
Abstract
Cardiac MRI of small animal models of cancer radiation therapy (RT) is a valuable tool for studying the effect of RT on the heart. However, standard cardiac MRI exams require long scanning times, which is challenging for sick animals that may not survive extended periods of imaging under anesthesia. The purpose of this study is to develop an optimized, fast MRI exam for comprehensive cardiac functional imaging of small-animal models of cancer RT. Ten adult female rats (2 non-irradiated and 8 irradiated) were scanned using the developed exam. Optimal imaging parameters were determined, which minimized scanning time while ensuring measurement accuracy and avoiding imaging artifacts. This optimized, fast MRI exam lasted for 30 min, which was tolerated by all animals. EF was normal in all imaged rats, although it was significantly increased in the irradiated rats, which also showed ventricular hypertrophy. However, myocardial strain was significantly reduced in the irradiated rats. In conclusion, a fast MRI exam has been developed for comprehensive cardiac functional imaging of rats in 30 min, with optimized imaging parameters to ensure accurate measurements and tolerance by irradiated rats. The generated strain measurements provide an early marker of regional cardiac dysfunction before global function is affected.
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Affiliation(s)
- El-Sayed H Ibrahim
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Dhiraj Baruah
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Matthew Budde
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Jason Rubenstein
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Anne Frei
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Rachel Schlaak
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Elizabeth Gore
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Carmen Bergom
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA; Washington University School of Medicine, 4511 Forest Park Ave, St. Louis, MI 63108, USA..
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Raman S, Erler D, Chin L, Cheung P, Chu W, Chung H, Loblaw D, Poon I, Rubenstein J, Soliman H, Sahgal A, Tseng C. Value of MRI in Contouring Non-spine Bone Metastases for Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2319] [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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Bergom C, Rubenstein J, Welsh A, Prior P, Eastwood D, Zhang MJ, Wilson JF, White J, Bradley J. Abstract 4749: A phase II study using cardiac MRI to assess cardiac injury in breast cancer patients receiving three-dimensional conformal regional nodal radiotherapy (3DCRT) with heart dose constraints. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4749] [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: 11/16/2022]
Abstract
Abstract
Purpose/Objectives: Regional nodal radiotherapy (RNR) can improve survival for node positive breast cancer (NPBC) patients, yet this benefit is offset by potential late cardiac toxicity. Most cardiac toxicity reports from RNR have been in eras where no specific dose or volume heart constraint was used. Cardiac MRI (CMR) is ideal to assess ventricular function and volumes. We report a phase II trial designed to assess cardiac injury by CMR in NPBC patients who received chemotherapy (CT) and RNR planned with 3DCRT using heart constraints.
Materials/Methods: 244 NPBC patients treated with 3DCRT RNR following surgery planned with heart constraints between 2000-2008 were screened. Eligibility included prior anthracycline CT, no cardiac disease pre-NPBC, and no recurrent disease. Patients with active atrial fibrillation were excluded. The cardiac dose constraint utilized was V25<10% of the heart. Mean heart dose was not constrained. Eligible women were invited via letter to enroll in the IRB-approved trial. CMR parameters to be evaluated included indicators of left ventricular (LV) function: ejection fraction (EF), LV mass (LVMI), and LV dimensions, as well as late gadolinium enhancement (LGE) and total heart extracellular volume fraction (ECV) as measures of cardiac injury and/or early cardiac fibrosis. Planned analysis included correlation of CMR parameters with cardiac dose-volume constraints using Spearman and Pearson correlations.
Results: The first 15 L-sided and 5 R-sided patients consented underwent CMR. Median age at diagnosis was 50 (32-77); median age at CMR was 60 (40-83). Median time after 3DCRT was 8.3 yr (5.7-14.4). The median L-sided mean heart dose was 4.8 Gy (1.1-11.2) and V25 was 5.7% (0-12%). No patient had clinical cardiac disease at time of CMR. Median LVEF was 63%. No LGE and no abnormal total heart ECV values (>25%) were obtained. Values mildly outside normal limits were seen for LVMI or LV dimensions in 4/15 (27%) L-sided and 2/5 (40%) right-sided patients. No correlations were seen between heart mean and max doses, V5, V10, V25, and V45 and the CMR variables of LVEF, LV mass, and LV dimensions. Two patients had valvular abnormalities found on CMR (L-sided with aortic regurgitation and R-sided with mitral regurgitation).
Conclusions: CMR findings were largely within normal limits at a median follow of 8.3 years in this cohort of NPBC patients who received prior cardiotoxic chemotherapy and RNR planned with heart constraints. A subset of patients had subclinical mildly abnormal LV measurements, but these did not correlate with heart dose or laterality, and the significance remains unknown. In this cohort, no significant cardiac injury from RNR as measured with CMR was seen. Conversely, CMR may not be a sensitive tool for subclinical partial heart injury from RNR. Larger corroborating studies are warranted.
Citation Format: Carmen Bergom, Jason Rubenstein, Aimee Welsh, Philip Prior, Daniel Eastwood, Mei-Jie Zhang, J. Frank Wilson, Julia White, Julie Bradley. A phase II study using cardiac MRI to assess cardiac injury in breast cancer patients receiving three-dimensional conformal regional nodal radiotherapy (3DCRT) with heart dose constraints [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4749. doi:10.1158/1538-7445.AM2017-4749
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Affiliation(s)
| | | | - Aimee Welsh
- 1Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | | | - Julia White
- 2The Ohio State University Comprehensive Cancer Center, Milwaukee, WI
| | - Julie Bradley
- 3University of Florida, College of Medicine, Jacksonville, FL
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Nayak L, Iwamoto F, Ferreri A, Santoro A, Singer S, Batlevi C, Batchelor T, Rubenstein J, Johnston P, Ramchandren R, Soussain C, Drappatz J, Becker K, Witzens-Harig M, Illerhaus G, Herrera A, Masood A, Shipp M. CHECKMATE 647: A PHASE 2, OPEN-LABEL STUDY OF NIVOLUMAB IN RELAPSED/REFRACTORY PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA OR RELAPSED/REFRACTORY PRIMARY TESTICULAR LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2440_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- L. Nayak
- Center for Neuro-oncology; Dana-Farber Cancer Institute; Boston USA
| | - F.M. Iwamoto
- Division of Neuro-Oncology; Columbia University Medical Center; New York USA
| | - A.J. Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - A. Santoro
- Department of Medical Oncology and Hematology, Humanitas Cancer Center; Humanitas University; Milan Italy
| | - S. Singer
- Neurological Oncology Division; Hackensack University Medical Center; Hackensack USA
| | - C. Batlevi
- Division of Hematologic Oncology; Memorial Sloan Kettering Cancer Center; New York USA
| | - T. Batchelor
- Department of Neurology; Massachusetts General Hospital; Boston USA
| | - J. Rubenstein
- Hematology and Blood and Marrow Transplant; University of California San Francisco Medical Center; San Francisco USA
| | - P. Johnston
- Hematology and Blood and Marrow Transplant; Mayo Clinic; Rochester USA
| | - R. Ramchandren
- Department of Hematology/Oncology; Barbara Ann Karmanos Cancer Institute; Detroit USA
| | - C. Soussain
- Department of Hematology; Institut Curie, Hôpital René-Huguenin; Saint-Cloud France
| | - J. Drappatz
- Division of Hematology/Oncology, Hillman Cancer Center; University of Pittsburgh Medical Center; Pittsburgh USA
| | - K. Becker
- Cancer Immunology; Yale Cancer Center; New Haven USA
| | - M. Witzens-Harig
- Department of Internal Medicine; University Hospital Heidelberg; Heidelberg Germany
| | - G. Illerhaus
- Department of Haematology/Oncology and Palliative Care; Klinikum Stuttgart; Stuttgart Germany
| | - A. Herrera
- Department of Hematology/Hematopoietic Cell Transplantation; City of Hope, Duarte USA
| | - A. Masood
- Global Clinical Research; Bristol-Myers Squibb; Lawrenceville USA
| | - M. Shipp
- Center for Hematologic Oncology; Dana-Farber Cancer Institute; Boston USA
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Sancaktar O, Shahir K, Baruah D, Welsh AC, Rubenstein J. Abnormal myocardial T1 mapping of hypertrophic cardiomyopathy in areas without delayed enhancement, as compared to NICM and controls at both 1.5 and 3T. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032700 DOI: 10.1186/1532-429x-18-s1-q45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bayin NS, Frenster JD, Kane JR, Rubenstein J, Modrek AS, Baitalmal R, Dolgalev I, Rudzenski K, Scarabottolo L, Crespi D, Redaelli L, Snuderl M, Golfinos JG, Doyle W, Pacione D, Parker EC, Chi AS, Heguy A, MacNeil DJ, Shohdy N, Zagzag D, Placantonakis DG. GPR133 (ADGRD1), an adhesion G-protein-coupled receptor, is necessary for glioblastoma growth. Oncogenesis 2016; 5:e263. [PMID: 27775701 PMCID: PMC5117849 DOI: 10.1038/oncsis.2016.63] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/09/2016] [Accepted: 08/24/2016] [Indexed: 02/06/2023] Open
Abstract
Glioblastoma (GBM) is a deadly primary brain malignancy with extensive intratumoral hypoxia. Hypoxic regions of GBM contain stem-like cells and are associated with tumor growth and angiogenesis. The molecular mechanisms that regulate tumor growth in hypoxic conditions are incompletely understood. Here, we use primary human tumor biospecimens and cultures to identify GPR133 (ADGRD1), an orphan member of the adhesion family of G-protein-coupled receptors, as a critical regulator of the response to hypoxia and tumor growth in GBM. GPR133 is selectively expressed in CD133+ GBM stem cells (GSCs) and within the hypoxic areas of PPN in human biospecimens. GPR133 mRNA is transcriptionally upregulated by hypoxia in hypoxia-inducible factor 1α (Hif1α)-dependent manner. Genetic inhibition of GPR133 with short hairpin RNA reduces the prevalence of CD133+ GSCs, tumor cell proliferation and tumorsphere formation in vitro. Forskolin rescues the GPR133 knockdown phenotype, suggesting that GPR133 signaling is mediated by cAMP. Implantation of GBM cells with short hairpin RNA-mediated knockdown of GPR133 in the mouse brain markedly reduces tumor xenograft formation and increases host survival. Analysis of the TCGA data shows that GPR133 expression levels are inversely correlated with patient survival. These findings indicate that GPR133 is an important mediator of the hypoxic response in GBM and has significant protumorigenic functions. We propose that GPR133 represents a novel molecular target in GBM and possibly other malignancies where hypoxia is fundamental to pathogenesis.
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Affiliation(s)
- N S Bayin
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
- Kimmel Center for Stem Cell Biology, New York University School of Medicine, New York, NY, USA
| | - J D Frenster
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
- Kimmel Center for Stem Cell Biology, New York University School of Medicine, New York, NY, USA
| | - J R Kane
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - J Rubenstein
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - A S Modrek
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - R Baitalmal
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - I Dolgalev
- Genome Technology Center, New York University School of Medicine, New York, NY, USA
| | - K Rudzenski
- Office for Therapeutic Alliances, New York University School of Medicine, New York, NY, USA
| | | | | | | | - M Snuderl
- Department of Pathology, New York University School of Medicine, New York, NY, USA
- Brain Tumor Center, New York University School of Medicine, New York, NY, USA
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - J G Golfinos
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
- Brain Tumor Center, New York University School of Medicine, New York, NY, USA
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - W Doyle
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - D Pacione
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - E C Parker
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - A S Chi
- Brain Tumor Center, New York University School of Medicine, New York, NY, USA
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - A Heguy
- Genome Technology Center, New York University School of Medicine, New York, NY, USA
| | - D J MacNeil
- Office for Therapeutic Alliances, New York University School of Medicine, New York, NY, USA
| | - N Shohdy
- Office for Therapeutic Alliances, New York University School of Medicine, New York, NY, USA
| | - D Zagzag
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
- Department of Pathology, New York University School of Medicine, New York, NY, USA
- Brain Tumor Center, New York University School of Medicine, New York, NY, USA
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - D G Placantonakis
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
- Kimmel Center for Stem Cell Biology, New York University School of Medicine, New York, NY, USA
- Brain Tumor Center, New York University School of Medicine, New York, NY, USA
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
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Halbe J, Fox J, Oujiri J, Roth J, Berger M, Rubenstein J. CLINICAL OUTCOMES AFTER CARDIAC MRI SCANS OF NON-MRI-SAFE CARDIAC IMPLANTABLE ELECTRONIC DEVICES. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Timmons M, Welsh AC, Baruah D, Shahir K, Rubenstein J. Right ventricular size assessed by cardiovascular MRI may predict mortality after left ventricular assist device placement. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328594 DOI: 10.1186/1532-429x-17-s1-p181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Curley M, Berger M, Roth J, Benjamin I, Rubenstein J. Predictors of mortality and major in-hospital adverse events associated with electrophysiology catheter ablation. JAMA Intern Med 2014; 174:815-7. [PMID: 24686853 DOI: 10.1001/jamainternmed.2014.415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael Curley
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Marcie Berger
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - James Roth
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Ivor Benjamin
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Jason Rubenstein
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee
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Baruah D, Rubenstein J, Shahir K. ‘Coronary wrap’: IgG4 related disease of coronary artery presenting as a mass lesion. Int J Cardiovasc Imaging 2014; 30:977-8. [DOI: 10.1007/s10554-014-0425-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
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Arakawa Y, Fujimoto KI, Murata D, Nakamoto Y, Okada T, Miyamoto S, Bahr O, Harter PN, Weise L, You SJ, Ronellenfitsch MW, Rieger J, Steinbach JP, Hattingen E, Bahr O, Jurcoane A, Daneshvar K, Pilatus U, Mittelbronn M, Steinbach JP, Hattingen E, Carrillo J, Bota D, Handwerker J, Su LMY, Chen T, Stathopoulos A, Yu H, Chang JH, Kim EH, Kim SH, Mi, Yun J, Pytel P, Collins J, Choi Y, Lukas R, Nicholas M, Colen R, Jafrani R, Zinn P, Colen R, Ashour O, Zinn P, Colen R, Vangel M, Gutman D, Hwang S, Wintermark M, Jain R, Jilwan-Nicolas M, Chen J, Raghavan P, Holder C, Rubin D, Huang E, Kirby J, Freymann J, Jaffe C, Flanders A, Zinn P, Colen R, Ashour O, Zinn P, Colen R, Zinn P, Dahiya S, Statsevych V, Elson P, Xie H, Chao S, Peereboom D, Stevens G, Barnett G, Ahluwalia M, Daras M, Karimi S, Abrey L, Sanchez J, Beal K, Gutin P, Kaley T, Grommes C, Correa D, Reiner A, Briggs S, Omuro A, Verburg N, Hoefnagels F, Pouwels P, Boellaard R, Barkhof F, Hoekstra O, Wesseling P, Reijneveld J, Heimans J, Vandertop P, Zwinderman K, Hamer HDW, Elinzano H, Kadivar F, Yadav PO, Breese VL, Jackson CL, Donahue JE, Boxerman JL, Ellingson B, Pope W, Lai A, Nghiemphu P, Cloughesy T, Ellingson B, Pope W, Chen W, Czernin J, Phelps M, Lai A, Nghiemphu P, Liau L, Cloughesy T, Ellingson B, Leu K, Tran A, Pope W, Lai A, Nghiemphu P, Harris R, Woodworth D, Cloughesy T, Ellingson B, Pope W, Leu K, Chen W, Czernin J, Phelps M, Lai A, Nghiemphu P, Liau L, Cloughesy T, Ellingson B, Enzmann D, Pope W, Lai A, Nghiemphu P, Liau L, Cloughesy T, Eoli M, Di Stefano AL, Aquino D, Scotti A, Anghileri E, Cuppini L, Prodi E, Finocchiaro G, Bruzzone MG, Fujimoto K, Arakawa Y, Murata D, Nakamoto Y, Okada T, Miyamoto S, Galldiks N, Stoffels G, Filss C, Dunkl V, Rapp M, Sabel M, Ruge MI, Goldbrunner R, Shah NJ, Fink GR, Coenen HH, Langen KJ, Guha-Thakurta N, Langford L, Collet S, Valable S, Constans JM, Lechapt-Zalcman E, Roussel S, Delcroix N, Bernaudin M, Abbas A, Ibazizene E, Barre L, Derlon JM, Guillamo JS, Harris R, Bookheimer S, Cloughesy T, Kim H, Pope W, Yang K, Lai A, Nghiemphu P, Ellingson B, Huang R, Rahman R, Hamdan A, Kane C, Chen C, Norden A, Reardon D, Mukundan S, Wen P, Jafrani R, Zinn P, Colen R, Jafrani R, Zinn P, Colen R, Jancalek R, Bulik M, Kazda T, Jensen R, Salzman K, Kamson D, Lee T, Varadarajan K, Robinette N, Muzik O, Chakraborty P, Barger G, Mittal S, Juhasz C, Kamson D, Barger G, Robinette N, Muzik O, Chakraborty P, Kupsky W, Mittal S, Juhasz C, Kinoshita M, Sasayama T, Narita Y, Kawaguchi A, Yamashita F, Chiba Y, Kagawa N, Tanaka K, Kohmura E, Arita H, Okita Y, Ohno M, Miyakita Y, Shibui S, Hashimoto N, Yoshimine T, Ronan LK, Eskey C, Hampton T, Fadul C, LaMontagne P, Milchenko M, Sylvester P, Benzinger T, Marcus D, Fouke SJ, Lupo J, Bian W, Anwar M, Banerjee S, Hess C, Chang S, Nelson S, Mabray M, Sanchez L, Valles F, Barajas R, Rubenstein J, Cha S, Miyake K, Ogawa D, Hatakeyama T, Kawai N, Tamiya T, Mori K, Ishikura R, Tomogane Y, Ando K, Izumoto S, Nelson S, Lieberman F, Lupo J, Viziri S, Nabors LB, Crane J, Wen P, Cote A, Peereboom D, Wen Q, Cloughesy T, Robins HI, Fisher J, Desideri S, Grossman S, Ye X, Blakeley J, Nonaka M, Nakajima S, Shofuda T, Kanemura Y, Nowosielski M, Wiestler B, Gobel G, Hutterer M, Schlemmer H, Stockhammer G, Wick W, Bendszus M, Radbruch A, Perreault S, Yeom K, Ramaswamy V, Shih D, Remke M, Luu B, Schubert S, Fisher P, Partap S, Vogel H, Poussaint TY, Taylor M, Cho YJ, Piludu F, Pace A, Fabi A, Anelli V, Villani V, Carapella C, Marzi S, Vidiri A, Pungavkar S, Tanawde P, Epari S, Patkar D, Lawande M, Moiyadi A, Gupta T, Jalali R, Rahman R, Akgoz A, You H, Hamdan A, Seethamraju R, Wen P, Young G, Rao A, Rao G, Flanders A, Ghosh P, Rao G, Martinez J, Rao A, Roh TH, Kim EH, Chang JH, Kushnirsky M, Katz J, Knisely J, Schulder M, Steinklein J, Rosen L, Warshall C, Nguyen V, Tiwari P, Rogers L, Wolansky L, Sloan A, Barnholtz-Sloan J, Tatsauka C, Cohen M, Madabhushi A, Rachinger W, Thon N, Haug A, Schuller U, Schichor C, Tonn JC, Tran A, Lai A, Li S, Pope W, Teixeira S, Harris R, Woodworth D, Nghiemphu P, Cloughesy T, Ellingson B, Villanueva-Meyer J, Barajas R, Mabray M, Barani I, Chen W, Shankaranarayanan A, Koon P, Cha S, Wen Q, Elkhaled A, Essock-Burns E, Molinaro A, Phillips J, Chang S, Cha S, Nelson S, Wolf D, Ye X, Lim M, Zhu H, Wang M, Quinones-Hinojosa A, Weingart J, Olivi A, van Zijl P, Laterra J, Zhou J, Blakeley J, Zakaria R, Das K, Sluming V, Bhojak M, Walker C, Jenkinson MD, (Tiger) Yuan S, Tao R, Yang G, Chen Z, Mu D, Zhao S, Fu Z, Li W, Yu J. RADIOLOGY. Neuro Oncol 2013; 15:iii191-iii205. [PMCID: PMC3823904 DOI: 10.1093/neuonc/not189] [Citation(s) in RCA: 2] [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: 08/14/2023] Open
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Curley M, Rubenstein J. PREDICTORS OF IN-HOSPITAL MORTALITY FOLLOWING EXTRACTION OF A CARDIAC IMPLANTABLE ELECTRONIC DEVICE. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Thounlasenh KJ, Prost RW, Rubenstein J. Experience with cardiac MR imaging of patients with legacy ICDs or pacemakers. J Cardiovasc Magn Reson 2013. [PMCID: PMC3560055 DOI: 10.1186/1532-429x-15-s1-t4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Khan L, Mitera G, Probyn L, Ford M, Christakis M, Finkelstein J, Donovan A, Zhang L, Zeng L, Rubenstein J, Yee A, Holden L, Chow E. Inter-rater reliability between musculoskeletal radiologists and orthopedic surgeons on computed tomography imaging features of spinal metastases. ACTA ACUST UNITED AC 2012; 18:e282-7. [PMID: 22184495 DOI: 10.3747/co.v18i6.797] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The primary objective of this pilot study was to examine the inter-rater reliability in scoring the computed tomography (ct) imaging features of spinal metastases in patients referred for radiotherapy (rt) for bone pain. METHODS In a retrospective review, 3 musculoskeletal radiologists and 2 orthopedic spinal surgeons independently evaluated ct imaging features for 41 patients with spinal metastases treated with rt in an outpatient radiation clinic from January 2007 to October 2008. The evaluation used spinal assessment criteria that had been developed in-house, with reference to osseous and soft tissue tumour extent,presence of a pathologic fracture,severity of vertebral height loss, andpresence of kyphosis.The Cohen kappa coefficient between the two specialties was calculated. RESULTS Mean patient age was 69.2 years (30 men, 11 women). The mean total daily oral morphine equivalent was 73.4 mg. Treatment dose-fractionation schedules included 8 Gy/1 (n = 28), 20 Gy/5 (n = 12), and 20 Gy/8 (n = 1). Areas of moderate agreement in identifying the ct imaging appearance of spinal metastasis included extent of vertebral body involvement (κ = 0.48) and soft-tissue component (κ = 0.59). Areas of fair agreement included extent of pedicle involvement (κ = 0.28), extent of lamina involvement (κ = 0.35), and presence of pathologic fracture (κ = 0.20). Areas of poor agreement included nerve-root compression (κ = 0.14) and vertebral body height loss (κ = 0.19). CONCLUSIONS The range of agreement between musculoskeletal radiologists and orthopedic surgeons for most spinal assessment criteria is moderate to poor. A consensus for managing challenging vertebral injuries secondary to spinal metastases needs to be established so as to best triage patients to the most appropriate therapeutic modality.
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Affiliation(s)
- L Khan
- Bone Metastases Site Group, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
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Dosoretz D, Mantz C, Salenius S, Fox A, Ross R, Rubenstein J, Katin M. Outcomes and Colostomy-Free Survival in Anal Cancer Patients Treated in a Community Setting. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Flynn CJ, Danjoux C, Wong J, Christakis M, Rubenstein J, Yee A, Yip D, Chow E. Two cases of acrometastasis to the hands and review of the literature. ACTA ACUST UNITED AC 2010; 15:51-8. [PMID: 19008991 PMCID: PMC2582515 DOI: 10.3747/co.v15i5.189] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [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] [Indexed: 01/06/2023]
Abstract
This paper reports two cases of acrometastasis to the hands. The first case involved a 78-year-old woman with a permeative osteolytic lesion in her proximal second metacarpal. A biopsy of this lesion suggested a diagnosis of non-small-cell lung carcinoma with secondary osseous metastasis. This was the first presentation of the woman’s primary diagnosis. A single 8-Gy fraction of palliative radiotherapy was delivered to the patient’s left hand. The treatment proved successful: the woman soon experienced pain relief and regained the use of her hand. The second case involved a 69-year-old woman with extensive lytic destruction involving the proximal two thirds of her third metacarpal. This patient had been diagnosed with carcinoma of the breast in 1990. She also received a single 8-Gy fraction of radiation, which improved both her pain and her hand mobility. An extensive review of the literature uncovered 257 previously reported cases of acrometastasis. Articles were analyzed based on age and sex of the patient, site of the primary carcinoma, metastatic locations within the hand and affected appendage or appendages, the treatment given, and the patient’s length of survival. Men were almost twice as likely to experience acrometastasis as women, and the median age of the patients overall was 58 years (range: 18 months–91 years). Lung, kidney, and breast carcinoma were the three most prevalent primary diagnoses reported in the literature. Cancers of the colon, stomach, liver, prostate, and rectum affected the remainder of the population. Overall, the right hand was more often host to the metastatic lesions. In addition, almost 10% of the patients experienced lesions in both hands. The third finger was the digit most affected by osseous metastases reported in the literature. Lesions of the thumb, fourth finger, second finger, and fifth finger were less commonly reported. The region of the digit most often affected within the patient population was the distal phalanx. The metacarpal bones, proximal phalanges, and middle phalanges comprised the remainder of the four most frequent acrometastatic sites. In the literature, single lesions were more prevalent than multiple bony lesions. Based on the reported cases, amputation appeared to be the preferred method of treatment. Radiation, excision, and systemic therapy were the next most frequently used treatments. Patient survival was not well documented within the literature. However, the median survival of patients in the reported cases was 6 months. Thus, our review suggested that a diagnosis of hand metastasis is an indication of poor prognosis. This report serves to emphasize the importance of properly diagnosing acrometastases. Identifying and effectively treating these metastases in a timely manner can lead to a dramatic improvement in a patient’s quality of life.
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Affiliation(s)
- C J Flynn
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, ON
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Dosoretz D, Fernandez E, Mantz C, Salenius S, Ross R, Rubenstein J, Katin M. From 2D to IMRT for Prostate Cancer: The Effect of Technology on Rectal and Urinary Toxicity in a Community Practice. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1180] [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: 11/25/2022]
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Grimm SA, McCannel CA, Omuro AMP, Ferreri AJM, Blay JY, Neuwelt EA, Siegal T, Batchelor T, Jahnke K, Shenkier TN, Hall AJ, Graus F, Herrlinger U, Schiff D, Raizer J, Rubenstein J, Laperriere N, Thiel E, Doolittle N, Iwamoto FM, Abrey LE. Primary CNS lymphoma with intraocular involvement: International PCNSL Collaborative Group Report. Neurology 2008; 71:1355-60. [PMID: 18936428 DOI: 10.1212/01.wnl.0000327672.04729.8c] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the demographics, diagnostic details, therapeutic management, and outcome in patients with primary CNS lymphoma (PCNSL) with ocular involvement. METHODS A retrospective study of 221 patients was assembled from 16 centers in seven countries. Only HIV-negative, immunocompetent patients with brain and ocular lymphoma were included; none had systemic lymphoma. RESULTS Median age at diagnosis was 60. Fifty-seven percent were women. Median Eastern Cooperative Oncology Group performance status was 2. Ocular disturbance and behavioral/cognitive changes were the most common presenting symptoms. Diagnosis of lymphoma was made by brain biopsy (147), vitrectomy (65), or CSF cytology (11). Diagnosis of intraocular lymphoma was made by vitrectomy/choroidal/retinal biopsy (90) or clinical ophthalmic examination (141). CSF cytology was positive in 23%. Treatment information was available for 176 patients. A total of 102 received dedicated ocular therapy (ocular radiotherapy 79, intravitreal methotrexate 22, and both 1) in addition to treatment for their brain lymphoma. Sixty-nine percent progressed at a median of 13 months; sites of progression included brain 52%, eyes 19%, brain and eyes 12%, and systemic 2%. Patients treated with local ocular therapy did not have a statistically significant decreased risk of failing in the eyes (p = 0.7). Median progression free survival and overall survival for the entire cohort were 18 and 31 months. CONCLUSION This is the largest reported series of primary CNS lymphoma (PCNSL) with intraocular involvement. Progression free and overall survival was similar to that reported with PCNSL. Dedicated ocular therapy improved disease control but did not affect overall survival.
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Affiliation(s)
- S A Grimm
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Montesinos-Rongen M, Brunn A, Bentink S, Basso K, Lim WK, Klapper W, Schaller C, Reifenberger G, Rubenstein J, Wiestler OD, Spang R, Dalla-Favera R, Siebert R, Deckert M. Gene expression profiling suggests primary central nervous system lymphomas to be derived from a late germinal center B cell. Leukemia 2007; 22:400-5. [PMID: 17989719 DOI: 10.1038/sj.leu.2405019] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To characterize the molecular origin of primary lymphomas of the central nervous system (PCNSL), 21 PCNSLs of immunocompetent patients were investigated by microarray-based gene expression profiling. Comparison of the transcriptional profile of PCNSL with various normal and neoplastic B-cell subsets demonstrated PCNSL (i) to display gene expression patterns most closely related to late germinal center B cells, (ii) to display a gene expression profile similar to systemic diffuse large B-cell lymphomas (DLBCLs) and (iii) to be in part assigned to the activated B-cell-like (ABC) or the germinal center B-cell-like (GCB) subtype of DLBCL.
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Affiliation(s)
- M Montesinos-Rongen
- Department of Neuropathology, University Hospital of Cologne, Cologne, Germany
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Hekler EB, Rubenstein J, Coups EJ, Gilligan S, Kusnecov AW, Contrada RJ, Steiner MJ, Tannenbaum AK, Leventhal EA, Krause TJ. Inflammatory Markers in Acute Myocardial Infarction Patients: Preliminary Evidence of a Prospective Association With Depressive Symptoms. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1751-9861.2007.00014.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: 11/28/2022]
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Issa S, Hwang J, Karch J, Fridlyand J, Prados M, Batchelor T, Aldape K, Haqq C, Damon L, Rubenstein J. Treatment of primary CNS lymphoma with induction high-dose methotrexate, temozolomide, rituximab followed by consolidation cytarabine/etoposide: A pilot study with biomarker analysis. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
7595 Background: There is currently no consensus on the optimal treatment for patients diagnosed with primary CNS lymphoma (PCNSL). Between 2001–2004, UCSF PCNSL patients were treated with combination high-dose methotrexate, temozolomide, rituximab (MTR) as induction therapy. Patients in CR with this regimen were treated with high-dose cytarabine plus etoposide as consolidation. The purposes of this study were: (1) Pilot analysis to determine the safety and efficacy of intensive methotrexate-based induction therapy followed by high-dose consolidation with elimination of whole brain irradiation; (2) Analysis of molecular markers in PCNSL which predict sensitivity to chemotherapy and outcome. Methods: 21 untreated, CD20 +, immunocompetent PCNSL patients were treated with combination methotrexate (8 gm/m²), temozolomide (150 mg/m²/day)and rituximab (375 mg/m²). Patients in CR received consolidation cytarabine (2 g/ m² x 8 doses) plus etoposide (40 mg/kg over 96 hours). IHC analysis of potential biomarkers predictive of outcome was performed on paraffin sections from these patients. Candidate markers for validation were selected by gene expression analysis of an independent, multicenter dataset of 20 cases. Results: Mean age was 58.6 y (range 40–81). Median KPS was 60. MTR and cytarabine/etoposide consolidation was well-tolerated with no treatment-related mortality or evidence for neurotoxicity. One case of post-remission cytopenia occurred after consolidation and resolved spontaneously. Eleven patients (52.4%) attained CR with induction; eight received consolidation; three patients in CR deferred consolidation. Median PFS was 11.5 months. Median OS for all 21 patients has not yet been reached with median follow-up of 27.5 months. Expression of the apoptotic regulator DAP-1 by lymphoma cells as determined by IHC was associated with improved PFS (p<0.028) and OS (p<0.021). Conclusions: Combination MTR followed by intensive consolidation appears to be well tolerated in PCNSL. PFS appears at least similar to regimens that contain whole brain irradiation. A larger phase II study has been initiated to evaluate this regimen in a multicenter setting. [Table: see text]
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Affiliation(s)
- S. Issa
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
| | - J. Hwang
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
| | - J. Karch
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
| | - J. Fridlyand
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
| | - M. Prados
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
| | - T. Batchelor
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
| | - K. Aldape
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
| | - C. Haqq
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
| | - L. Damon
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
| | - J. Rubenstein
- University of California San Francisco, San Francisco, CA; Massachusetts General Hospital, Boston, MA; M. D. Anderson Cancer Center, Houston, TX
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Sung L, Young NL, Greenberg ML, McLimont M, Samanta T, Wong J, Rubenstein J, Ingber S, Doyle JJ, Feldman BM. Health-related quality of life (HRQL) scores reported from parents and their children with chronic illness differed depending on utility elicitation method. J Clin Epidemiol 2005; 57:1161-6. [PMID: 15567632 DOI: 10.1016/j.jclinepi.2004.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the relationship between health-related quality of life (HRQL) as measured by utility when elicited from parents and their children with chronic illness. STUDY DESIGN AND SETTING We enrolled families of children admitted for cancer chemotherapy and those attending outpatient rheumatology, hemophilia and bone marrow transplantation clinics. Children in grade 6 or higher were included. The child's HRQL was rated by parent and child using the Standard Gamble (SG), Visual Analogue Scale (VAS), Time Trade-Off (TTO), and Health Utilities Index Mark 2/3 (HUI2 and HUI3). RESULTS 22 families were included. The mean parent SG was 0.92 +/- 0.09, which was similar to the mean SG elicited from their children of 0.92 +/- 0.10. The parent and child SG were moderately concordant (ICC=0.64, 95% CI=0.30, 0.83; P=.0005). In contrast, TTO scores were not concordant (ICC=0.14, 95% CI=-0.29, 0.53; P=.3), with parents (mean TTO=0.77 +/- 0.31) rating HRQL worse than children (mean TTO=0.92 +/- 0.11; P=.04). Similarly, the mean parent HUI2 of 0.82 +/- 0.22 was lower than the child HUI2 of 0.95 +/- 0.07; P=.02 and HUI2 were not concordant (ICC=0.11, 95% CI=-0.35, 0.53; P=.3) between parents and children. CONCLUSION Parents and children rate HRQL similarly according to SG, but parents rate HRQL significantly worse using TTO and HUI2.
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Affiliation(s)
- L Sung
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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Finlay M, Sherman C, Rubenstein J, Wierzbicki R, Chow E. A late relapse of primary Krukenberg tumour with bone metastases. Clin Oncol (R Coll Radiol) 2003; 15:500-3. [PMID: 14690008 DOI: 10.1016/s0936-6555(03)00194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M Finlay
- Department of Radiation Oncology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada
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Sung L, Greenberg ML, Young NL, McLimont M, Ingber S, Rubenstein J, Wong J, Samanta T, Doyle JJ, Stain AM, Feldman BM. Validity of a modified standard gamble elicited from parents of a hospital-based cohort of children. J Clin Epidemiol 2003; 56:848-55. [PMID: 14505769 DOI: 10.1016/s0895-4356(03)00160-4] [Citation(s) in RCA: 10] [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: 11/29/2022]
Abstract
OBJECTIVES To examine the validity of a modified standard gamble (Mod SG) (nondeath baseline) by comparing these scores to SG (death baseline), time trade off (TTO), visual analog scale (VAS), Health Utilities Index (HUI), and Child Health Questionnaire (CHQ). METHODS Respondents were parents of in-patients with cancer receiving chemotherapy and parents of children without cancer attending outpatient clinics. Construct validity was determined by comparing a priori hypotheses to actual correlations between measures. Discriminant validity was examined by anticipating that in-patients with cancer would have lower HRQL than outpatients. RESULTS 85 families were included. Both Mod SG and SG were moderately correlated with TTO (r=0.50 and r=0.49; P<.01 for both). Both Mod SG and SG were moderately correlated with TTO (r=0.47 and r=0.05, P<0.002 for both). CONCLUSION The Mod SG did not perform better than SG. Two nonoverlapping groups of HRQL measures were demonstrated.
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Affiliation(s)
- L Sung
- Division of Hematology/Oncology, and Population Health Sciences, Hospital for Sick Children, Toronto, Ontario, M5G 1X8
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Sung L, Greenberg ML, Doyle JJ, Young NL, Ingber S, Rubenstein J, Wong J, Samanta T, McLimont M, Feldman BM. Construct validation of the Health Utilities Index and the Child Health Questionnaire in children undergoing cancer chemotherapy. Br J Cancer 2003; 88:1185-90. [PMID: 12698182 PMCID: PMC2747569 DOI: 10.1038/sj.bjc.6600895] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The objective of this study was to evaluate the construct validity of two questionnaire-based measures of health-related quality of life (HRQL) in children undergoing cancer chemotherapy: the Health Utilities Index (HUI) and the Child Health Questionnaire (CHQ). Subjects were children hospitalised for chemotherapy. To examine construct validity: (1). a priori expected relations between CHQ concepts and HUI attributes were examined; (2). HUI and CHQ summary scores were compared to visual analogue scale (VAS) scores. Ease of completion was rated using a 5-point categorical scale and completion time was recorded. A total of 36 subjects were included. The maximum score was seen in 15 (47%) of HUI3 assessments. As predicted, CHQ body pain was moderately correlated with HUI3 pain (r=0.51), CHQ physical functioning was moderately correlated with HUI2 mobility (r=0.58) and CHQ mental health was moderately correlated with HUI2 emotion (r=0.53). Only the CHQ psychosocial subscale (and not HUI) was correlated with VAS (r=0.44). The CHQ and the HUI were both easy to use. The HUI questionnaires required less time to complete (mean=3.1, s.d.=1 min) compared with CHQ (mean=13.1, s.d.=3.4 min, P<0.0001). In conclusion, HUI and CHQ demonstrated construct validity in children undergoing cancer chemotherapy. The Health Utilities Index is subject to a ceiling effect whereas CHQ requires more time to complete.
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Affiliation(s)
- L Sung
- Department of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada.
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Qi Y, Cai J, Wu Y, Wu R, Lee J, Fu H, Rao M, Sussel L, Rubenstein J, Qiu M. Control of oligodendrocyte differentiation by the Nkx2.2 homeodomain transcription factor. Development 2001; 128:2723-33. [PMID: 11526078 DOI: 10.1242/dev.128.14.2723] [Citation(s) in RCA: 228] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Oligodendrocytes are derived from glial precursors that arise from the ventral neural tube early in development. In the developing chicken CNS, oligodendrocyte progenitors selectively express Nkx2.2 homeodomain transcription factor, raising the possibility that Nkx2.2 may directly regulate oligogliogenesis. In this study, we have examined Nkx2.2 expression in rodent glial precursors and studied the effect of a loss of Nkx2.2 on oligodendrocyte and astrocyte differentiation. We show that Nkx2.2 is also expressed in mammalian oligodendrocyte progenitors and that the differentiation of MBP-positive and PLP-DM20-positive oligodendrocytes is dramatically retarded in Nkx2.2-null mutants along the entire rostrocaudal axis. In contrast, no effect is seen on astrocytic differentiation. Interestingly, absence of Nkx2.2 expression leads to a ventral expansion of the Olig1/Olig2 expression in neuroepithelial cells into the Nkx2.2 domain and a consequent increase in the production of Olig1/Olig2-positive and platelet-derived growth factor receptor α-positive oligodendrocyte progenitors. These results strongly suggest that Nkx2.2 regulates the differentiation and/or maturation, but not the initial specification, of oligodendrocyte progenitors. Consistent with this suggestion, overproduction of Nkx2.2 protein in fibroblast cells can induce gene expression from the proteolipid protein promoter.
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Affiliation(s)
- Y Qi
- Department of Anatomical Sciences and Neurobiology, School of Medicine, University of Louisville, Louisville, KY 40292, USA
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Affiliation(s)
- A G Fam
- Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada
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Lavedan C, Dehejia A, Pike B, Dutra A, Leroy E, Ide SE, Root H, Rubenstein J, Boyer RL, Chandrasekharappa S, Makalowska I, Nussbaum RL, Polymeropoulos MH. Contig map of the Parkinson's disease region on 4q21-q23. DNA Res 1998; 5:19-23. [PMID: 9628579 DOI: 10.1093/dnares/5.1.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We have constructed a yeast artificial chromosome contig (YAC) map of human chromosome 4q21-q23 across the Parkinson's disease region by combining molecular and fluorescence in situ hybridization techniques. This map contains 55 YACs and 51 molecular markers, including 23 polymorphic markers. We have also isolated one P1 and 33 bacterial artificial chromosomes located within this contig. Plasmid libraries were generated from 11 of these BAC and P1 clones, and 614 random plasmid clones were sequenced for a total of about 200 kb. This contig allowed us to precisely determine the location of 18 transcripts within the D4S2460-D4S2986 interval, including the alpha-synuclein gene found to be mutated in some families with Parkinson's disease.
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Affiliation(s)
- C Lavedan
- Laboratory of Genetic Disease Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Silverstein J, Rubenstein J, Millman A, Panko W. Web-based segmentation and display of three-dimensional radiologic image data. Stud Health Technol Inform 1997; 50:53-9. [PMID: 10180586] [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: 02/11/2023]
Abstract
In many clinical circumstances, viewing sequential radiological image data as three-dimensional models is proving beneficial. However, designing customized computer-generated radiological models is beyond the scope of most physicians, due to specialized hardware and software requirements. We have created a simple method for Internet users to remotely construct and locally display three-dimensional radiological models using only a standard web browser. Rapid model construction is achieved by distributing the hardware intensive steps to a remote server. Once created, the model is automatically displayed on the requesting browser and is accessible to multiple geographically distributed users. Implementation of our server software on large scale systems could be of great service to the worldwide medical community.
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Affiliation(s)
- J Silverstein
- University of Illinois, Chicago School of Biomedical and Health Information Sciences 60612-7249, USA.
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Affiliation(s)
- J Rubenstein
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, North York, Ontario, Canada
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Polymeropoulos MH, Lavedan C, Leroy E, Ide SE, Dehejia A, Dutra A, Pike B, Root H, Rubenstein J, Boyer R, Stenroos ES, Chandrasekharappa S, Athanassiadou A, Papapetropoulos T, Johnson WG, Lazzarini AM, Duvoisin RC, Di Iorio G, Golbe LI, Nussbaum RL. Mutation in the alpha-synuclein gene identified in families with Parkinson's disease. Science 1997. [PMID: 9197268 DOI: 10.1126/science.276.5321.204] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder with a lifetime incidence of approximately 2 percent. A pattern of familial aggregation has been documented for the disorder, and it was recently reported that a PD susceptibility gene in a large Italian kindred is located on the long arm of human chromosome 4. A mutation was identified in the alpha-synuclein gene, which codes for a presynaptic protein thought to be involved in neuronal plasticity, in the Italian kindred and in three unrelated families of Greek origin with autosomal dominant inheritance for the PD phenotype. This finding of a specific molecular alteration associated with PD will facilitate the detailed understanding of the pathophysiology of the disorder.
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Affiliation(s)
- M H Polymeropoulos
- Laboratory of Genetic Disease Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-1430, USA
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Polymeropoulos MH, Lavedan C, Leroy E, Ide SE, Dehejia A, Dutra A, Pike B, Root H, Rubenstein J, Boyer R, Stenroos ES, Chandrasekharappa S, Athanassiadou A, Papapetropoulos T, Johnson WG, Lazzarini AM, Duvoisin RC, Di Iorio G, Golbe LI, Nussbaum RL. Mutation in the alpha-synuclein gene identified in families with Parkinson's disease. Science 1997; 276:2045-7. [PMID: 9197268 DOI: 10.1126/science.276.5321.2045] [Citation(s) in RCA: 5776] [Impact Index Per Article: 213.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder with a lifetime incidence of approximately 2 percent. A pattern of familial aggregation has been documented for the disorder, and it was recently reported that a PD susceptibility gene in a large Italian kindred is located on the long arm of human chromosome 4. A mutation was identified in the alpha-synuclein gene, which codes for a presynaptic protein thought to be involved in neuronal plasticity, in the Italian kindred and in three unrelated families of Greek origin with autosomal dominant inheritance for the PD phenotype. This finding of a specific molecular alteration associated with PD will facilitate the detailed understanding of the pathophysiology of the disorder.
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Affiliation(s)
- M H Polymeropoulos
- Laboratory of Genetic Disease Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-1430, USA
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Barondes SH, Alberts BM, Andreasen NC, Bargmann C, Benes F, Goldman-Rakic P, Gottesman I, Heinemann SF, Jones EG, Kirschner M, Lewis D, Raff M, Roses A, Rubenstein J, Snyder S, Watson SJ, Weinberger DR, Yolken RH. Workshop on schizophrenia. Proc Natl Acad Sci U S A 1997; 94:1612-4. [PMID: 9050825 PMCID: PMC34140 DOI: 10.1073/pnas.94.5.1612] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
On November 29-30, 1995, the National Academy of Sciences and the Institute of Medicine brought together experts in schizophrenia and specialists in other areas of the biological sciences in a workshop aimed at promoting the application of the latest biological information to this clinical problem. The workshop paid particular attention to evidence of pathology in the brains of people with schizophrenia, and to the possibility that this reflects an abnormality in brain development that eventually leads to the appearance of symptoms. The participants were impressed with the complexity of the problem, and felt that multiple approaches would be required to understand this disease. They recommended that a major focus should be on the search for predisposing genes, but that there should be parallel research in many other areas.
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Affiliation(s)
- S H Barondes
- Department of Psychiatry, Center for Neurobiology and Psychiatry, University of California, San Francisco 94143-0984, USA
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Polymeropoulos MH, Hurko O, Hsu F, Rubenstein J, Basnet S, Lane K, Dietz H, Spetzler RF, Rigamonti D. Linkage of the locus for cerebral cavernous hemangiomas to human chromosome 7q in four families of Mexican-American descent. Neurology 1997; 48:752-7. [PMID: 9065560 DOI: 10.1212/wnl.48.3.752] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To determine with greater precision the map location of the locus associated with familial cavernous hemangiomas. BACKGROUND Cavernous malformations of the brain are a significant cause of seizures, progressive or apoplectic neurologic deficit, and headache. Prevalence estimates from autopsy series vary from 0.39 to 0.9%. This disorder (OMIM #116860) can be inherited as an autosomal dominant trait with variable penetrance. Linkage to markers on the long arm of chromosome 7 was recently reported in separate reports in three apparently unrelated Hispanic kindreds as well as in two kindreds of non-Hispanic descent. DESIGN/METHODS We examined clinically, by MRI scanning, and by pathologic examination of surgical specimens, members of four large Mexican-American families segregating cavernous hemangiomas of the brain. Linkage analysis was performed with use of blood specimens from morphologically proven cases. Two-point linkage analysis was performed with the MLINK program of the LINKAGE package. Multipoint analysis was performed between two markers and the disease locus with LINKMAP in the FASTLINKAGE package. Allele frequencies were set as described by the Genome Database (GDB). Maximum penetrance for the disease allele was set to 0.75. RESULTS The highest lod score was observed for marker D7S652 with Zmax = 6.66 at theta(max) = 0.00. Multipoint LOD score analysis placed the disease locus in the 11 cM interval between markers D7S630 and D7S527 with Zmax = 9.19. Haplotype analysis is in agreement with the placement of the disease gene between D7S630 and D7S527 and further shows a minimal shared region within this interval, indicating a founder effect in the establishment of the mutation in these families. CONCLUSIONS We confirmed the linkage of cavernous hemangioma to markers on the long arm of chromosome 7q, and the estimate of the map location has been refined to a region of shared haplotype between markers D7S630 and D7S527 in four Mexican-American families who may be descended from a common ancestor in Sonora County, Mexico.
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Affiliation(s)
- M H Polymeropoulos
- Laboratory of Genetic Disease Research, National Center for Human Genome Research, National Institutes of Health, Bethesda, MD 20892, USA
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Abstract
OBJECTIVES With the increasing use of endourologic procedures to diagnose and treat urologic problems, the urologist's exposure to radiation from fluoroscopy becomes an important safety consideration. Although collimation of the x-ray beam generally prevents direct radiation exposure by the urologist, the patient absorbs radiation during the procedure and becomes a secondary source of exposure through radiation scatter. METHODS We measured radiation exposure to the urologist during endourologic procedures using standard body shields and thyroid collars. We repeated our surveys using a newly designed urologic surgery radiation shield. RESULTS We found dose rates to the urologist of up to 1100 mrem per hour of flouroscopy time. The maximum yearly whole-body exposure as recommended by the National Council on Radiation Protection is 5000 mrem, or 5 rem. CONCLUSIONS Urologists should be cognizant of this radiation risk, and the concepts of time, distance, and shielding are critically important to know in efforts to reduce radiation exposure. We introduce a newly designed fluoroscopic drape which reduces the radiation dosage to the urologist from scatter nearly 70-fold. We found this shield to be very practical and easy to use, and we offer it as an effective safeguard against secondary radiation exposure.
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Affiliation(s)
- J G Giblin
- Department of Surgery (Urology), Georgetown University Medical Center, Washington, DC 20007, USA
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Lefkowith JB, Kiehl M, Rubenstein J, DiValerio R, Bernstein K, Kahl L, Rubin RL, Gourley M. Heterogeneity and clinical significance of glomerular-binding antibodies in systemic lupus erythematosus. J Clin Invest 1996; 98:1373-80. [PMID: 8823302 PMCID: PMC507563 DOI: 10.1172/jci118924] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.8] [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: 02/02/2023] Open
Abstract
We used an ELISA employing extracts of human glomerular basement membrane (GBM) to detect, characterize, and evaluate the clinical significance of glomerular-binding IgG in patients with SLE nephritis. Most patients with SLE nephritis exhibited GBM-binding IgG, although many patients with active nonrenal SLE or symptomatic, drug-induced lupus had similar reactivity, albeit at lower levels. IgG binding to GBM in SLE nephritis patients was decreased by DNase pretreatment of GBM, restored after DNase with nuclear antigens (most notably with nucleosomes), inhibited by exogenous nuclear antigens (particularly nucleosomes), but unaffected by exposure of serum to DNase/high ionic strength. The characteristics of IgG binding to GBM largely paralleled the patients' underlying autoimmune response, which was dominated either by antibodies to DNA/nucleosomes or to nucleosomes alone. Binding of lupus sera to nonrenal extracellular matrix (even with nucleosomes) was not equivalent to GBM. Collagenase pretreatment of GBM variably decreased IgG binding, depending on the level and type of binding. SLE nephritis patients with high levels of GBM-binding IgG exhibited more severe disease clinically, but the same renal histopathology, as patients with lower levels. The level of GBM-binding IgG at presentation did not predict the therapeutic response, but decreased in responders to therapy. In sum, glomerular-binding IgG in lupus nephritis binds to epitopes on chromatin, which adheres to GBM in part via collagen. These autoantibodies appear necessary, but not sufficient, for the development of nephritis, and correlate with clinical rather than histopathologic parameters of disease activity.
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Affiliation(s)
- J B Lefkowith
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Abstract
Hematogenous metastasis to the psoas muscle is rare, and the resulting clinical symptoms may mimic psoas abscess or hemorrhage. When the clinical history is not specific, CT is important in documenting the presence of a psoas mass and providing biopsy guidance for histologic diagnosis. Only three previously reported cases have been related to a primary carcinoma of the lung.
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Affiliation(s)
- S Nash
- Department of Medical Imaging, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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Fam AG, Stein J, Rubenstein J. Gouty arthritis in nodal osteoarthritis. J Rheumatol 1996; 23:684-9. [PMID: 8730127] [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: 02/01/2023]
Abstract
OBJECTIVE To analyze the clinical features and identify factors associated with the development of gouty arthritis in nodal osteoarthritis (OA). METHODS Thirty-two consecutive patients (21 women and 11 men, mean age 75.8 years) with both nodal OA and crystal proven acute gout and/or tophi of distal/proximal interphalangeal (DIP/PIP) joints were studied between 1986 and 1994. RESULTS Tophi of DIP and/or PIP joints were present in 29 (90%) patients; alone in 9 and together with acute DIP or PIP gouty arthritis in 20. Three patients had acute DIP or PIP gouty episodes but no digital tophi. Mean pretreatment serum urate was 614.9 +/- 163.2 (range 422-1088 mumol/l). Risk factors for gout included diuretic use (81%), renal failure (59%), hypertension (66%), alcoholism (22%), prophylactic low dose ASA (20%), and a positive family history (16%) of patients. CONCLUSION The coexistence of gouty arthritis in nodal OA is important to recognize and treat, particularly in elderly women with renal failure, hypertension, or cardiac failure who are receiving longterm diuretic therapy.
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Affiliation(s)
- A G Fam
- Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada
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Polymeropoulos MH, Ortiz De Luna RI, Ide SE, Torres R, Rubenstein J, Francomano CA. The gene for pycnodysostosis maps to human chromosome 1cen-q21. Nat Genet 1995; 10:238-9. [PMID: 7663522 DOI: 10.1038/ng0695-238] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pycnodysostosis (OMIM 265800) is an autosomal recessive skeletal disorder first described by Maroteaux and Lamy that is characterized by short stature, increased bone density, delayed closure of cranial sutures, loss of the mandibular angle, dysplastic clavicles, dissolution of the terminal phalanges of the hands and feet, dental abnormalities and increased bone fragility. Patients have a typical appearance secondary to prominence of the calvarium, smallness of the facial features, prominent nose and micrognathia. The French painter, Henri de Toulouse Lautrec (1864-1901), is believed to have had the disorder. Although more than 100 cases have been reported, we are aware of only two large consanguinous pedigrees in which the pycnodysostosis disorder segregates. We have studied the segregation of the pycnodysostosis phenotype in a large consanguinous Mexican pedigree, the clinical features of which are very similar to those described in the Arab pedigree studied by Edelson et al. Here, we report linkage for the pycnodysostosis phenotype in the 1cen-q21 region of human chromosome 1, and discuss candidate genes for this skeletal disorder.
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Polymeropoulos MH, Coon H, Byerley W, Gershon ES, Goldin L, Crow TJ, Rubenstein J, Hoff M, Holik J, Smith AM. Search for a schizophrenia susceptibility locus on human chromosome 22. Am J Med Genet 1994; 54:93-9. [PMID: 8074169 DOI: 10.1002/ajmg.1320540203] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We used 10 highly informative DNA polymorphic markers and genetic linkage analysis to examine whether a gene locus predisposing to schizophrenia is located on chromosome 22, in 105 families with schizophrenia and schizoaffective disorder. The LOD score method, including analysis for heterogeneity, provided no conclusive evidence of linkage under a dominant, recessive, or penetrance free model of inheritance. Affected sib-pair analysis was inconclusive. Affected pedigree member analysis gave only suggestive evidence for linkage. Multipoint APM analysis, using 4 adjacent loci including D22S281 and IL2RB, a region of interest from the APM analysis, gave non-significant results for the three different weighting functions.
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Affiliation(s)
- M H Polymeropoulos
- Laboratory of Biochemical Genetics, NIMH, Washington, District of Columbia
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Stroz PM, Rubenstein J, Gershater R, Murray J, Orsini E. Case report 838: Osteoid osteoma. Skeletal Radiol 1994; 23:241-3. [PMID: 8016681 DOI: 10.1007/bf00197472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- P M Stroz
- Department of Radiology, Sunnybrook Health Science Centre, University of Toronto, Canada
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Fam AG, Rubenstein J. Another look at spinal tuberculosis. J Rheumatol 1993; 20:1731-40. [PMID: 8295186] [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
The steady decline in tuberculosis rates in Canada has led to a certain lack of awareness of the disease. We describe 7 patients with culture proven spinal tuberculosis, seen in a teaching hospital over a 10-year period. Persistent spinal pain and local tenderness were the most frequent presenting findings. There was a mean delay in diagnosis of 5.2 (range 1-18) months from the time of presentation. Only 2 patients had active extraspinal tuberculous infection. Plain spinal radiographs were the initial diagnostic procedure of choice showing a destructive vertebral lesion in 5 of 7 patients. Computed tomography (CT) played an important role in delineating the discovertebral lesion and in demonstrating a paraspinal soft tissue infection in 6 (85%) of 7 patients: psoas abscess in 4 (2 with epidural extension), epidural abscess in one, and a neck abscess in one. Magnetic resonance imaging (MRI) in one patient enabled a more complete definition of the vertebral infection and its soft tissue extensions. Two patients were successfully treated with combination antituberculous chemotherapy alone, and 5 required adjuvant surgical procedures. Our study stresses the need for increased alertness to this now uncommon but treatable spinal infection, and emphasizes the diagnostic usefulness of CT and MRI in defining subtle discovertebral lesions and in detecting unsuspected paravertebral soft tissue extension.
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Affiliation(s)
- A G Fam
- Divison of Rheumatology, Sunnybrook Health Science Centre, University of Toronto, ON, Canada
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Fam AG, Rubenstein J, Saibil F. Pyomyositis: early detection and treatment. J Rheumatol 1993; 20:521-4. [PMID: 8478863] [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: 01/31/2023]
Abstract
We describe a patient with Crohn's disease and pyomyositis due to Streptococcus anginosus ("milleri"). Early recognition of pyomyositis during its presuppurative phase allowed for prompt antibiotic treatment and rapid resolution of the muscle infection without surgical drainage.
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Affiliation(s)
- A G Fam
- Division of Rheumatology, Sunnybrook Health Science Centre, University of Toronto, ON, Canada
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