1
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Callegari M, Danziger-Isakov LA, Rose A, Kaul D, Shaffer K, Chong PP, Florescu D, German K, Avery R, Nguyen MH, Wildfeuer B, Michaels MG, Green M, Guo K, Zhao L, Daud A, Ison MG. Presentation, anagement, and outcomes of norovirus in adult and pediatric solid organ and hematopoietic stem cell transplant recipients: A multicenter, retrospective study. Transpl Infect Dis 2024:e14270. [PMID: 38526183 DOI: 10.1111/tid.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/20/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Norovirus (NoV) can cause chronic relapsing and remitting diarrhea in immunocompromised patients. Few multicenter studies have described the clinical course, outcomes, and complications of chronic NoV in transplant recipients. METHODS A multicenter retrospective study of adult and pediatric SOT and HSCT recipients diagnosed with NoV between November 1, 2017, and February 28, 2021. Data were obtained from electronic medical records (EMR) and entered into a central REDCap database. Descriptive statistics were calculated. RESULTS A total of 280 NoV+ patients were identified across eight sites. The majority were adults (74.1%) and SOT recipients (91.4%). Initial diagnosis of NoV occurred a median of 36 months post-Tx (IQR [15.0, 90.0]). Most NoV cases had >3 diarrheal episodes daily (66.0%), nausea and vomiting (60.1%). Duration of diarrhea varied greatly (median = 10 days, mean = 85.9 days, range (1, 2100)). 71.3% were hospitalized. Adjustment of immunosuppression, including reduction and discontinuation of mToR inhibitor, CNI, and/or MMF, was the most common management intervention for NoV. Other therapies resulted only in temporary improvement. Four patients died within 30 days and three others died by 180 days postdiagnosis. Clinically significant renal dysfunction was observed in 12.5% by 30 days and 21.4% by 180 days post-NoV diagnosis. CONCLUSION In HSCT and SOT patients, NoV frequently resulted in severe symptoms, prolonged diarrhea (30% persistent with diarrhea for >30 days), and clinically significant renal dysfunction (up to 21% of patients). Utilized therapies did not reliably result in the resolution of infection demonstrating the need for more effective treatment.
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Affiliation(s)
- Michelle Callegari
- Divisions of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lara A Danziger-Isakov
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Anne Rose
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Kaul
- Division of Infectious Disease, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kelly Shaffer
- Division of Infectious Disease, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Pearlie P Chong
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Diana Florescu
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaci German
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robin Avery
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brett Wildfeuer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael Green
- Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kexin Guo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amna Daud
- Divisions of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael G Ison
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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2
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Perepezko K, Shaffer K, Beach S, Rolle N, Fields B. Effects of Caregiver Sleep Disturbances on Relationship Quality With Their Care Recipient. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad137. [PMID: 37738509 DOI: 10.1093/geronb/gbad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVES Sleep problems are highly prevalent and disruptive for caregivers. Although the connection between caregivers' sleep and outcomes like caregiver burden and quality of life is well established, the potential influence of caregivers' sleep on their reported relationship quality with the care recipient is not known. The current study sought to address this gap. METHODS We analyzed data from the 2017 National Health and Aging Trends Study and linked it with data from the 2017 National Study of Caregiving. Our dependent variable was caregiver-reported relationship quality, and our predictor variable of interest was caregiver sleep problems. We also included several covariates related to the caregiver and care recipient. We used a generalized linear model to examine the relationship between caregiver sleep problems and relationship quality, controlling for other potentially influential factors. RESULTS Sleep problems were significantly related to relationship quality. Compared to caregivers who reported no sleep problems, those who reported at least one sleep problem (β: -0.23, 95% CI: -0.46 to -0.01) had lower relationship quality with the care recipient. Other factors that remained related to relationship quality in the generalized linear model were negative aspects of caregiving, emotional difficulties, caregiver race, relationship type, care recipient depressive symptoms, and care recipient sex. DISCUSSION Sleep problems are influential health behaviors that are related to relationship quality for caregivers. Therefore, it is critical that sleep is more systematically assessed and addressed in caregiving populations.
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Affiliation(s)
- Kate Perepezko
- National Center on Family Support, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kelly Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Scott Beach
- National Center on Family Support, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Natalie Rolle
- Center for Community Partnerships, Colorado State University, Fort Collins, Colorado, USA
| | - Beth Fields
- National Center on Family Support, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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3
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Gibson CA, Gupta A, Naik A, Sullivan DK, Doshi M, Backes J, Harvey S, Lee J, Mount R, Valentine H, Shaffer K. Developing a Healthy Lifestyle Program for Recent Kidney Transplant Recipients. Prog Transplant 2023; 33:193-200. [PMID: 37469164 DOI: 10.1177/15269248231189878] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Many kidney transplant recipients experience weight gain in the first year after transplantation. RESEARCH QUESTION The objective of this research study was to assess the desires of recent kidney transplant patients about the design features of a healthy lifestyle program to counter unnecessary weight gain. DESIGN In this descriptive study, recent recipients at 2 transplant centers were invited to participate in an online survey. Survey items included sociodemographic information, current medications, health conditions, weight change posttransplant, diet behaviors, physical activity participation, and desired features of a lifestyle program. RESULTS Fifty-three participants, mean age 60.5 (11.2) years, primarily males, completed surveys. Forty percent gained weight posttransplantation with many indicating struggling with their diet. Physical activity levels stayed the same (17%) or decreased (40%) posttransplantation. Eighty-seven percent of participants indicated they would participate in an online lifestyle program and 76% wanted online physical activity and nutrition sessions to meet at least once weekly. Suggestions about the type of information and activities, included eating strategies (eg, how to eat healthfully at restaurants, grocery shopping tips, and recipes), resources for at-home physical activities, access to cooking classes, and apps to track both activity and food intake. CONCLUSION Recent kidney transplant recipients would benefit from and desired to join a lifestyle program featuring tailored nutrition education and physical activity coaching. Gathered information will be used to inform and tailor a lifestyle program. Identifying features for the prevention of unnecessary weight gain with patients' input is essential for promoting and sustaining healthy behaviors.
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Affiliation(s)
- Cheryl A Gibson
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aditi Gupta
- Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abhijit Naik
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mona Doshi
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jim Backes
- Department of Pharmacy Practice, University of Kansas Medical Center, Kansas City, KS, USA
| | - Susan Harvey
- Department of Health, Sports, and Exercise Sciences, University of Kansas, Robinson Center, Lawrence, KS, USA
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, Texas Tech University, Lubbock, TX, USA
| | - Rebecca Mount
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Heather Valentine
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly Shaffer
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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4
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Rayaprolu V, Fulton BO, Rafique A, Arturo E, Williams D, Hariharan C, Callaway H, Parvate A, Schendel SL, Parekh D, Hui S, Shaffer K, Pascal KE, Wloga E, Giordano S, Negron N, Ni M, Copin R, Atwal GS, Franklin M, Boytz RM, Donahue C, Davey R, Baum A, Kyratsous CA, Saphire EO. Structure of the Inmazeb cocktail and resistance to Ebola virus escape. Cell Host Microbe 2023; 31:260-272.e7. [PMID: 36708708 PMCID: PMC10375381 DOI: 10.1016/j.chom.2023.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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] [Received: 03/07/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 01/28/2023]
Abstract
Monoclonal antibodies can provide important pre- or post-exposure protection against infectious disease for those not yet vaccinated or in individuals that fail to mount a protective immune response after vaccination. Inmazeb (REGN-EB3), a three-antibody cocktail against Ebola virus, lessened disease and improved survival in a controlled trial. Here, we present the cryo-EM structure at 3.1 Å of the Ebola virus glycoprotein, determined without symmetry averaging, in a simultaneous complex with the antibodies in the Inmazeb cocktail. This structure allows the modeling of previously disordered portions of the glycoprotein glycan cap, maps the non-overlapping epitopes of Inmazeb, and illuminates the basis for complementary activities and residues critical for resistance to escape by these and other clinically relevant antibodies. We further provide direct evidence that Inmazeb protects against the rapid emergence of escape mutants, whereas monotherapies even against conserved epitopes do not, supporting the benefit of a cocktail versus a monotherapy approach.
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Affiliation(s)
| | | | | | - Emilia Arturo
- La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Dewight Williams
- Eyring Materials Center, Arizona State University, Tempe, AZ 85281, USA
| | | | | | - Amar Parvate
- La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | | | | | - Sean Hui
- La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Kelly Shaffer
- La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | | | | | | | | | - Min Ni
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | | | | | | | - Ruth Mabel Boytz
- Department of Microbiology, Boston University of Medicine and NEIDL, Boston University, Boston, MA 02118, USA
| | - Callie Donahue
- Department of Microbiology, Boston University of Medicine and NEIDL, Boston University, Boston, MA 02118, USA
| | - Robert Davey
- Department of Microbiology, Boston University of Medicine and NEIDL, Boston University, Boston, MA 02118, USA
| | - Alina Baum
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | | | - Erica Ollmann Saphire
- La Jolla Institute for Immunology, La Jolla, CA 92037, USA; Department of Medicine, University of California, San Diego, San Diego, CA 92037, USA.
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5
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Mattos M, Bernacchi V, Shaffer K, Gallagher V, Seo S, Manning C. SLEEP AND CAREGIVER BURDEN FOR CAREGIVERS OF PERSONS WITH DEMENTIA: A SCOPING REVIEW. Innov Aging 2022. [PMCID: PMC9767115 DOI: 10.1093/geroni/igac059.2917] [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: 12/24/2022] Open
Abstract
Caregivers of persons with dementia report worse sleep when compared to the general population. This scoping review synthesizes evidence regarding the link between caregiver burden and dementia caregivers’ sleep. A systematic search was completed in PubMed, CINAHL, PsycINFO, and Web of Science for pertinent literature published through March 2022. Included original research articles studied informal adult caregivers of persons living with mild cognitive impairment or dementia, documented the relationship between subjective caregiver burden and caregiver sleep, and were written in English. Extracted data were organized in tables, compared, and synthesized. The search yielded 540 non-duplicate articles screened by title and abstract; 118 full-text articles were reviewed; of these, 26 were included. Most studies were cross-sectional, with variable sample sizes (range n=40–669). Sleep was operationalized across the 25 quantitative studies in terms of subjective quality (n=19) and objective sleep parameters using actigraphy (n=4), and polysomnography (n=2). Of studies reporting subjective sleep quality, 16 reported a significant positive association between caregiver burden (84%) with the remaining found null results. Half of the studies that used objective measures of sleep (actigraphy and polysomnography) found a positive association between sleep and caregiver burden, while the other half did not (n=3). Results suggest that, while subjective sleep quality is commonly impacted by dementia caregiving burden, there is a lack of corresponding evidence on the relationship between burden and objective sleep metrics. Caregiver burden was also not measured consistently across studies, and future studies should focus on consistent measurement of caregiver burden and determination of directionality.
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Affiliation(s)
- Meghan Mattos
- University of Virginia, School of Nursing, Charlottesville, Virginia, United States
| | - Veronica Bernacchi
- Penn State College of Medicine, State College, Pennsylvania, United States
| | - Kelly Shaffer
- University of Virginia, Charlottesville, Virginia, United States
| | | | - Shinae Seo
- University of Virginia, School of Nursing, Charlottesville, Virginia, United States
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6
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Ritterband L, Shaffer K, Thorndike F, Ingersoll K, Cohn W, Chow P, Frederick C, MacDonnell K, Glazer J, Heath G, Le N, Finkelstein E, Gonder-Frederick L, Quigg M, Bashir M, Morin C. An RCT of an Internet Intervention for Insomnia Tailored for Older Adults (SHUTi-OASIS). Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.301] [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: 10/17/2022]
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7
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Shaffer K, Glazer J, Ingersoll K, Ritterband L. Testing an Internet-delivered insomnia program among family cancer caregivers: Use, satisfaction, and preliminary effects. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.381] [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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8
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Wykoff J, Shaffer K, Araba K, Markovetz M, Patarin J, Robert de Saint vincent M, Donaldson S, Ehre C. 388 Rapid viscoelastic characterization of airway mucus using a benchtop rheometer. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01078-5] [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: 11/07/2022]
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9
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Peng W, Rayaprolu V, Parvate AD, Pronker MF, Hui S, Parekh D, Shaffer K, Yu X, Saphire EO, Snijder J. Glycan shield of the ebolavirus envelope glycoprotein GP. Commun Biol 2022; 5:785. [PMID: 35927436 PMCID: PMC9352669 DOI: 10.1038/s42003-022-03767-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022] Open
Abstract
The envelope glycoprotein GP of the ebolaviruses is essential for host cell entry and the primary target of the host antibody response. GP is heavily glycosylated with up to 17 N-linked sites, numerous O-linked glycans in its disordered mucin-like domain (MLD), and three predicted C-linked mannosylation sites. Glycosylation is important for host cell attachment, GP stability and fusion activity, and shielding from neutralization by serum antibodies. Here, we use glycoproteomics to profile the site-specific glycosylation patterns of ebolavirus GP. We detect up to 16 unique O-linked glycosylation sites in the MLD, and two O-linked sites in the receptor-binding GP1 subunit. Multiple O-linked glycans are observed within N-linked glycosylation sequons, suggesting crosstalk between the two types of modifications. We confirmed C-mannosylation of W288 in full-length trimeric GP. We find complex glycosylation at the majority of N-linked sites, while the conserved sites N257 and especially N563 are enriched in unprocessed glycans, suggesting a role in host-cell attachment via DC-SIGN/L-SIGN. Our findings illustrate how N-, O-, and C-linked glycans together build the heterogeneous glycan shield of GP, guiding future immunological studies and functional interpretation of ebolavirus GP-antibody interactions. Site-specific N-, O-, and C-linked glycans are characterized in the ebolavirus envelope glycoprotein GP using mass spectrometry-based glycoproteomics.
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Affiliation(s)
- Weiwei Peng
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Padualaan 8, 3584, CH, Utrecht, The Netherlands
| | - Vamseedhar Rayaprolu
- Center for Infectious Disease and Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, 92037, USA.,Pacific Northwest Center for CryoEM, Portland, OR, 97225, USA
| | - Amar D Parvate
- Center for Infectious Disease and Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, 92037, USA.,Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, 99354, USA
| | - Matti F Pronker
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Padualaan 8, 3584, CH, Utrecht, The Netherlands
| | - Sean Hui
- Center for Infectious Disease and Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, 92037, USA.,Molecular Microbiology and Microbial Pathogenesis Program, Washington University School of Medicine, Saint Louis, MO, 63108, USA
| | - Diptiben Parekh
- Center for Infectious Disease and Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, 92037, USA
| | - Kelly Shaffer
- Center for Infectious Disease and Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, 92037, USA.,Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Xiaoying Yu
- Center for Infectious Disease and Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, 92037, USA
| | - Erica O Saphire
- Center for Infectious Disease and Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, 92037, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA, 92039, USA
| | - Joost Snijder
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Padualaan 8, 3584, CH, Utrecht, The Netherlands.
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10
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Araba K, Santhanam P, Shaffer K, Morrison C, Gilmore R, Ehre C. 215: Mucus hyperconcentration initiates bowel obstruction in the distal ileum of CF mice. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Shaffer K, Morrison C, Araba K, Markovitz M, Quinney N, Morton L, Hill D, O’Neal W, Kesimer M, Gentzsch M, Ehre C. 179: Modulator therapy reverses aberrant mucus properties in vitro via hydration. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Hastie KM, Li H, Bedinger D, Schendel SL, Dennison SM, Li K, Rayaprolu V, Yu X, Mann C, Zandonatti M, Diaz Avalos R, Zyla D, Buck T, Hui S, Shaffer K, Hariharan C, Yin J, Olmedillas E, Enriquez A, Parekh D, Abraha M, Feeney E, Horn GQ, Aldon Y, Ali H, Aracic S, Cobb RR, Federman RS, Fernandez JM, Glanville J, Green R, Grigoryan G, Lujan Hernandez AG, Ho DD, Huang KYA, Ingraham J, Jiang W, Kellam P, Kim C, Kim M, Kim HM, Kong C, Krebs SJ, Lan F, Lang G, Lee S, Leung CL, Liu J, Lu Y, MacCamy A, McGuire AT, Palser AL, Rabbitts TH, Rikhtegaran Tehrani Z, Sajadi MM, Sanders RW, Sato AK, Schweizer L, Seo J, Shen B, Snitselaar JL, Stamatatos L, Tan Y, Tomic MT, van Gils MJ, Youssef S, Yu J, Yuan TZ, Zhang Q, Peters B, Tomaras GD, Germann T, Saphire EO. Defining variant-resistant epitopes targeted by SARS-CoV-2 antibodies: A global consortium study. Science 2021; 374:472-478. [PMID: 34554826 PMCID: PMC9302186 DOI: 10.1126/science.abh2315] [Citation(s) in RCA: 183] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Abstract
Antibody-based therapeutics and vaccines are essential to combat COVID-19 morbidity and mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Multiple mutations in SARS-CoV-2 that could impair antibody defenses propagated in human-to-human transmission and spillover or spillback events between humans and animals. To develop prevention and therapeutic strategies, we formed an international consortium to map the epitope landscape on the SARS-CoV-2 spike protein, defining and structurally illustrating seven receptor binding domain (RBD)–directed antibody communities with distinct footprints and competition profiles. Pseudovirion-based neutralization assays reveal spike mutations, individually and clustered together in variants, that affect antibody function among the communities. Key classes of RBD-targeted antibodies maintain neutralization activity against these emerging SARS-CoV-2 variants. These results provide a framework for selecting antibody treatment cocktails and understanding how viral variants might affect antibody therapeutic efficacy.
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Affiliation(s)
- Kathryn M. Hastie
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Haoyang Li
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Daniel Bedinger
- Carterra, 825 N. 300 W. Ste C309, Salt Lake City, UT 84103, USA
| | - Sharon L. Schendel
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - S. Moses Dennison
- Center for Human Systems Immunology, Departments of Surgery, Immunology, and Molecular Genetics and Microbiology and Duke Human Vaccine Institute, Duke University, Durham, NC 27701, USA
| | - Kan Li
- Center for Human Systems Immunology, Departments of Surgery, Immunology, and Molecular Genetics and Microbiology and Duke Human Vaccine Institute, Duke University, Durham, NC 27701, USA
| | - Vamseedhar Rayaprolu
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Xiaoying Yu
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Colin Mann
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Michelle Zandonatti
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Ruben Diaz Avalos
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Dawid Zyla
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Tierra Buck
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Sean Hui
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Kelly Shaffer
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Chitra Hariharan
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Jieyun Yin
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Eduardo Olmedillas
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Adrian Enriquez
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Diptiben Parekh
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Milite Abraha
- Center for Human Systems Immunology, Departments of Surgery, Immunology, and Molecular Genetics and Microbiology and Duke Human Vaccine Institute, Duke University, Durham, NC 27701, USA
| | - Elizabeth Feeney
- Center for Human Systems Immunology, Departments of Surgery, Immunology, and Molecular Genetics and Microbiology and Duke Human Vaccine Institute, Duke University, Durham, NC 27701, USA
| | - Gillian Q. Horn
- Center for Human Systems Immunology, Departments of Surgery, Immunology, and Molecular Genetics and Microbiology and Duke Human Vaccine Institute, Duke University, Durham, NC 27701, USA
| | - CoVIC-DB team1
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
- Carterra, 825 N. 300 W. Ste C309, Salt Lake City, UT 84103, USA
- Center for Human Systems Immunology, Departments of Surgery, Immunology, and Molecular Genetics and Microbiology and Duke Human Vaccine Institute, Duke University, Durham, NC 27701, USA
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam Infection & Immunity Institute, 1105 AZ Amsterdam, Netherlands
- Quadrucept Bio, Ltd., Cambridge CB23 6DW, UK
- Myrio Therapeutics Pty, Ltd., 1 Dalmore Drive, Scoresby, VIC 3179, Australia
- National Resilience, Inc., 13200 NW Nano Ct., Alachua, FL 32615, USA
- Generate Biomedicines, Inc., 26 Landsdowne Street, Cambridge, MA 02139, USA
- Activemotif, Inc., 1914 Palomar Oaks Way, Suite 150, Carlsbad, CA 92008, USA
- Centivax, Inc., 201 Gateway Blvd., Floor 1, South San Francisco, CA 94080, USA
- Twist Bioscience, 681 Gateway Blvd., South San Francisco, CA 94080, USA
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, 701 West 168th St., HHSC 1102, New York, NY 10032, USA
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital and Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
- Shanghai Henlius Biotech, Inc., 9/F, Innov Tower, Zone A, no. 1801 Hongmei Road, Xuhui District, Shanghai, China
- Kymab, Ltd., The Bennet Building, Babraham Research Campus, Cambridge CB22 3AT, UK
- Department of Infectious Disease, Imperial College, London SW7 2AZ, UK
- Celltrion, Inc., Department of Research and Development, 23 Academy-ro Yeonsu-gu Incheon, Republic of Korea
- Sanyou Biopharmaceuticals Co., Ltd., no. 188 Xinjunhuan Road, Building 6B-C, 3rd Floor, Minhang District, Shanghai 201114, China
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
- Shanghai Key Laboratory of Medical Epigenetics, International Laboratory of Medical Epigenetics and Metabolism, Ministry of Science and Technology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- AbCipher Biotechnology, 188 Xinjun Ring Road, Building 2, 4th Floor, Minhang District, Shanghai 201114, China
- Fred Hutchinson Cancer Research Center, Vaccines and Infectious Diseases Division, Seattle, WA, USA
- Institute of Cancer Research, Centre for Cancer Drug Discovery, London SM2 5NG, UK
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD 21201, USA
- HiFiBiO, Inc., 237 Putnam Avenue, Cambridge, MA 02139, USA
- National Resilience, Inc., 2061 Challenger Dr., Alameda, CA 94501, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
| | - Yoann Aldon
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam Infection & Immunity Institute, 1105 AZ Amsterdam, Netherlands
| | - Hanif Ali
- Quadrucept Bio, Ltd., Cambridge CB23 6DW, UK
| | - Sanja Aracic
- Myrio Therapeutics Pty, Ltd., 1 Dalmore Drive, Scoresby, VIC 3179, Australia
| | - Ronald R. Cobb
- National Resilience, Inc., 13200 NW Nano Ct., Alachua, FL 32615, USA
| | - Ross S. Federman
- Generate Biomedicines, Inc., 26 Landsdowne Street, Cambridge, MA 02139, USA
| | - Joseph M. Fernandez
- Activemotif, Inc., 1914 Palomar Oaks Way, Suite 150, Carlsbad, CA 92008, USA
| | - Jacob Glanville
- Centivax, Inc., 201 Gateway Blvd., Floor 1, South San Francisco, CA 94080, USA
| | - Robin Green
- Generate Biomedicines, Inc., 26 Landsdowne Street, Cambridge, MA 02139, USA
| | - Gevorg Grigoryan
- Generate Biomedicines, Inc., 26 Landsdowne Street, Cambridge, MA 02139, USA
| | | | - David D. Ho
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, 701 West 168th St., HHSC 1102, New York, NY 10032, USA
| | - Kuan-Ying A. Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital and Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
| | - John Ingraham
- Generate Biomedicines, Inc., 26 Landsdowne Street, Cambridge, MA 02139, USA
| | - Weidong Jiang
- Shanghai Henlius Biotech, Inc., 9/F, Innov Tower, Zone A, no. 1801 Hongmei Road, Xuhui District, Shanghai, China
| | - Paul Kellam
- Kymab, Ltd., The Bennet Building, Babraham Research Campus, Cambridge CB22 3AT, UK
- Department of Infectious Disease, Imperial College, London SW7 2AZ, UK
| | - Cheolmin Kim
- Celltrion, Inc., Department of Research and Development, 23 Academy-ro Yeonsu-gu Incheon, Republic of Korea
| | - Minsoo Kim
- Celltrion, Inc., Department of Research and Development, 23 Academy-ro Yeonsu-gu Incheon, Republic of Korea
| | - Hyeong Mi Kim
- Celltrion, Inc., Department of Research and Development, 23 Academy-ro Yeonsu-gu Incheon, Republic of Korea
| | - Chao Kong
- Sanyou Biopharmaceuticals Co., Ltd., no. 188 Xinjunhuan Road, Building 6B-C, 3rd Floor, Minhang District, Shanghai 201114, China
| | - Shelly J. Krebs
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Fei Lan
- Activemotif, Inc., 1914 Palomar Oaks Way, Suite 150, Carlsbad, CA 92008, USA
- Shanghai Key Laboratory of Medical Epigenetics, International Laboratory of Medical Epigenetics and Metabolism, Ministry of Science and Technology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Guojun Lang
- Sanyou Biopharmaceuticals Co., Ltd., no. 188 Xinjunhuan Road, Building 6B-C, 3rd Floor, Minhang District, Shanghai 201114, China
| | - Sooyoung Lee
- Celltrion, Inc., Department of Research and Development, 23 Academy-ro Yeonsu-gu Incheon, Republic of Korea
| | - Cheuk Lun Leung
- Generate Biomedicines, Inc., 26 Landsdowne Street, Cambridge, MA 02139, USA
| | - Junli Liu
- Shanghai Henlius Biotech, Inc., 9/F, Innov Tower, Zone A, no. 1801 Hongmei Road, Xuhui District, Shanghai, China
| | - Yanan Lu
- Activemotif, Inc., 1914 Palomar Oaks Way, Suite 150, Carlsbad, CA 92008, USA
- AbCipher Biotechnology, 188 Xinjun Ring Road, Building 2, 4th Floor, Minhang District, Shanghai 201114, China
| | - Anna MacCamy
- Fred Hutchinson Cancer Research Center, Vaccines and Infectious Diseases Division, Seattle, WA, USA
| | - Andrew T. McGuire
- Fred Hutchinson Cancer Research Center, Vaccines and Infectious Diseases Division, Seattle, WA, USA
| | - Anne L. Palser
- Kymab, Ltd., The Bennet Building, Babraham Research Campus, Cambridge CB22 3AT, UK
| | - Terence H. Rabbitts
- Quadrucept Bio, Ltd., Cambridge CB23 6DW, UK
- Institute of Cancer Research, Centre for Cancer Drug Discovery, London SM2 5NG, UK
| | - Zahra Rikhtegaran Tehrani
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD 21201, USA
| | - Mohammad M. Sajadi
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD 21201, USA
| | - Rogier W. Sanders
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam Infection & Immunity Institute, 1105 AZ Amsterdam, Netherlands
| | - Aaron K. Sato
- Twist Bioscience, 681 Gateway Blvd., South San Francisco, CA 94080, USA
| | | | - Jimin Seo
- Celltrion, Inc., Department of Research and Development, 23 Academy-ro Yeonsu-gu Incheon, Republic of Korea
| | - Bingqing Shen
- HiFiBiO, Inc., 237 Putnam Avenue, Cambridge, MA 02139, USA
| | - Jonne L. Snitselaar
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam Infection & Immunity Institute, 1105 AZ Amsterdam, Netherlands
| | - Leonidas Stamatatos
- Fred Hutchinson Cancer Research Center, Vaccines and Infectious Diseases Division, Seattle, WA, USA
| | - Yongcong Tan
- Sanyou Biopharmaceuticals Co., Ltd., no. 188 Xinjunhuan Road, Building 6B-C, 3rd Floor, Minhang District, Shanghai 201114, China
| | - Milan T. Tomic
- National Resilience, Inc., 2061 Challenger Dr., Alameda, CA 94501, USA
| | - Marit J. van Gils
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam Infection & Immunity Institute, 1105 AZ Amsterdam, Netherlands
| | - Sawsan Youssef
- Centivax, Inc., 201 Gateway Blvd., Floor 1, South San Francisco, CA 94080, USA
| | - Jian Yu
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, 701 West 168th St., HHSC 1102, New York, NY 10032, USA
| | - Tom Z. Yuan
- Twist Bioscience, 681 Gateway Blvd., South San Francisco, CA 94080, USA
| | - Qian Zhang
- HiFiBiO, Inc., 237 Putnam Avenue, Cambridge, MA 02139, USA
| | - Bjoern Peters
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
| | - Georgia D. Tomaras
- Center for Human Systems Immunology, Departments of Surgery, Immunology, and Molecular Genetics and Microbiology and Duke Human Vaccine Institute, Duke University, Durham, NC 27701, USA
| | - Timothy Germann
- Carterra, 825 N. 300 W. Ste C309, Salt Lake City, UT 84103, USA
| | - Erica Ollmann Saphire
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
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13
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Rastogi A, Hanna RM, Mkrttchyan A, Khalid M, Yaqoob S, Shaffer K, Dhawan P, Nobakht N, Kamgar M, Goshtaseb R, Sarmosyan K, Gnarini M, Wassef O, Lerma E. Sodium zirconium cyclosilicate for the management of chronic hyperkalemia in kidney disease, a novel agent. Expert Rev Clin Pharmacol 2021; 14:1055-1064. [PMID: 34227913 DOI: 10.1080/17512433.2021.1932460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hyperkalemia is a common finding in patients with advanced kidney disease for multiple reasons. Renin-Angiotensin-Aldosterone-System Inhibitors (RAASi) that are indicated for slowing down progression of kidney disease are often associated with hyperkalemia which becomes a limiting factor in their use and titration to the maximum dose. Having a safe, effective, tolerable, and affordable potassium binder can help optimize RAAS inhibition in the setting of kidney disease. AREAS COVERED Although sodium polystyrene sulfonate has been a mainstay of acute management of hyperkalemia for decades, evidence regarding its efficacy is limited, and its chronic use is not routinely recommended for concerns regarding toxicity. The concern of gastrointestinal (GI) adverse effects with sodium polystyrene sulfonate has spurred the development of alternatives. Sodium zirconium cyclosilicate (SZC) is a promising agent that selectively binds potassium in the gut and eliminates it, while being safe for chronic use based on 1 year of data. Even though we do not have head-to-head studies among the three currently available binders, SZC stands out in rapidity of onset and efficacy. EXPERT OPINION In this review, we summarize the general management of hyperkalemia, including new agents. We review the pre-clinical and clinical data relating to sodium zirconium cyclosilicate.
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Affiliation(s)
- Anjay Rastogi
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Ramy M Hanna
- Department of Medicine, Division of Nephrology, University of California Irvine Medical Center, USA
| | - Anita Mkrttchyan
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Maham Khalid
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Sinan Yaqoob
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Kelly Shaffer
- Department of Medicine, UCLA CORE Kidney Health Program Collaborator, USA
| | - Puneet Dhawan
- Division of Cardiothoracic Surgery at David Geffen School of Medicine, UCLA, USA
| | - Niloofar Nobakht
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Mohammad Kamgar
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Ray Goshtaseb
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Kristine Sarmosyan
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | | | - Olivia Wassef
- Department of Medicine, UCLA CORE Kidney Health Program Collaborator, USA
| | - Edgar Lerma
- Division of Nephrology, University of Illinois at Chicago, Chicago, USA
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14
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Meyers E, Lin A, Lester E, Shaffer K, Rosand J, Vranceanu AM. Baseline resilience and depression symptoms predict trajectory of depression in dyads of patients and their informal caregivers following discharge from the Neuro-ICU. Gen Hosp Psychiatry 2019; 62:87-92. [PMID: 31887641 PMCID: PMC6948176 DOI: 10.1016/j.genhosppsych.2019.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/23/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore the impact of resiliency factors on the longitudinal trajectory of depressive symptoms in patients admitted to the Neuroscience Intensive Care Unit (Neuro-ICU) and their family caregivers. MATERIALS AND METHODS Patients (N = 102) and family caregivers (N = 103) completed self-report assessments of depressive symptoms (depression subscale of the Hospital Anxiety and Depression Scale; HADS-D) and resiliency factors (i.e., mindfulness and coping) during Neuro-ICU hospitalization. The HADS-D was administered again at 3 and 6 months after discharge. The Actor-Partner Interdependence Model (APIM) was used to assess patient-caregiver interdependence. RESULTS Baseline rates of clinically significant depressive symptoms were high among patients (23%) and caregivers (19%), and remained elevated through 6-months. Higher depressive symptoms predicted higher levels of symptoms at the subsequent timepoint (ps < 0.05). Higher baseline mindfulness and coping were associated with lower levels of depressive symptoms at all timepoints (ps < 0.001). APIM analysis showed that one's own higher baseline mindfulness was associated with concurrent levels of depressive symptoms in a partner (p < 0.05). CONCLUSIONS Depressive symptoms in Neuro-ICU patient-caregiver dyads are high through 6 months. Mindfulness is protective against depressive symptoms and interdependent between patients and caregivers. Early, dyadic, mindfulness-based interventions may prevent the development of chronic depression in both patients and caregivers.
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Affiliation(s)
- Emma Meyers
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Ann Lin
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ethan Lester
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kelly Shaffer
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
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15
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Feldsine PT, Jucker MT, Kaur M, Lienau AH, Kerr DE, Adamson A, Beaupre L, Bishop J, Casasola E, Cote C, Desilets S, D’lima C, Elahimanesh P, Fitzgerald S, Forgey R, Fortin J, Gohil V, Griffin J, Hardin M, Kaur D, Ketrenos J, King A, Kupski B, Luce S, Lucia L, Maeda S, Markun D, Marquez-Gonzalez M, McClendon J, McKessock J, Nelson C, Nguyen T, O’Brien C, Ramos M, Reilly S, Roa N, Schiffelbein Z, Shaffer K, Shepherd D, Sowell S, Trujillo E, Wang S, Williams K. Evaluation of the Assurance GDS® for Salmonella Method in Foods and Environmental Surfaces: Multilaboratory Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/93.1.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A multilaboratory collaborative study was conducted to compare the detection of Salmonella by the Assurance GDS® for Salmonella method and the Reference culture methods. Six foods, representing a variety of low microbial and high microbial load foods were analyzed. Seventeen laboratories in the United States and Canada participated in this study. No statistical differences (P < 0.05) were observed between the Assurance GDS for Salmonella and the Reference culture methods for any inoculation level of any food type or naturally contaminated food, except for pasta, for which the Assurance GDS method had a higher number of confirmed test portions for Salmonella compared to the Reference method.
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Affiliation(s)
| | - Markus T Jucker
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Mandeep Kaur
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Andrew H Lienau
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - David E Kerr
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
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16
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Rastogi A, Ameen KM, Al-Baghdadi M, Shaffer K, Nobakht N, Kamgar M, Lerma EV. Autosomal dominant polycystic kidney disease: updated perspectives. Ther Clin Risk Manag 2019; 15:1041-1052. [PMID: 31692482 PMCID: PMC6716585 DOI: 10.2147/tcrm.s196244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/31/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited multisystem disorder, characterized by renal and extra-renal fluid-filled cyst formation and increased kidney volume that eventually leads to end-stage renal disease. ADPKD is considered the fourth leading cause of end-stage renal disease in the United States and globally. Care of patients with ADPKD was, for a long time, limited to supportive lifestyle measures, due to the lack of therapeutic strategies targeting the main pathways involved in the pathophysiology of ADPKD. As the first FDA approved treatment of ADPKD, Vasopressin (V2) receptor blocking agent, tolvaptan, is an urgently awaited advance for ADPKD patients. In our review, we also shed some lights on what is beyond Tolvaptan as there are other medications in the pipeline and many medications have been or are currently being studied in clinical trials such as Tesevatinib, Metformin and Pravastatin, with the goal of slowing the rate of progression of ADPKD by reducing the increase in total kidney volume or maintaining eGFR. Here, we review updates in the perspectives and management of ADPKD.
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Affiliation(s)
- Anjay Rastogi
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Khalid Mohammed Ameen
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Maha Al-Baghdadi
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kelly Shaffer
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Niloofar Nobakht
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mohammad Kamgar
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Edgar V Lerma
- Department of Medicine, Divison of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Section of Nephrology, Oak Lawn, IL, USA
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17
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Shaffer K, Ingersoll K, Chow P, Thorndike F, Bailey E, Shepard J, Ritterband L. Timing and tailoring of internet-based cognitive-behavioral treatment for insomnia for cancer survivors: A qualitative study. Psychooncology 2019; 28:1934-1937. [PMID: 31319444 DOI: 10.1002/pon.5180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Kelly Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia
| | - Karen Ingersoll
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia
| | - Philip Chow
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia
| | | | - Elaine Bailey
- Student Health, University of Virginia, Charlottesville, Virginia
| | - Jaclyn Shepard
- Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia
| | - Lee Ritterband
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia
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18
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McFarland DC, Shaffer K, Breitbart W, Rosenfeld B, Miller AH. C-reactive protein and its association with depression in patients receiving treatment for metastatic lung cancer. Cancer 2018; 125:779-787. [PMID: 30521079 DOI: 10.1002/cncr.31859] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/11/2018] [Accepted: 10/09/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Depression is highly prevalent in lung cancer. Although there is a known association between inflammation and depression, this relationship has not been examined in patients with lung cancer who undergo treatment with immune and other targeted drug therapies. Peripheral blood C-reactive protein (CRP), a marker of systemic inflammation, may help identify metastatic lung cancer patients with inflammation-associated depression. METHOD Patients with metastatic lung cancer undergoing treatment were evaluated for depression using the Hospital Anxiety and Depression Scale (HADS). Inflammation (CRP and CRP cutoffs ≥1 and ≥3 mg/mL) and demographic and treatment variables were analyzed for association with depression. RESULTS One hundred nine consecutive participants exhibited an average plasma CRP concentration of 1.79 mg/mL (median, 0.75 mg/mL [standard deviation, 2.5 mg/mL), and 20.7% had a CRP concentration of ≥3.0 mg/mL; 23.9% met depression screening criteria (HADS ≥8). A log transformation of CRP was significantly correlated with depression severity (r = 0.47, P < .001). CRP was the only covariate to predict depression severity (P = .008) in a multivariate model including lung cancer disease subtype and type of systemic treatment. Receiver operating characteristic analysis indicated that CRP had moderate predictive accuracy in identifying elevated depression (area under the curve = 0.74). A cutoff of CRP ≥3.0 generated high specificity (88%) but identified only 50% of those with elevated depression. CONCLUSION Elevated CRP is associated with depression in patients with metastatic lung cancer. Thus, CRP may identify a subset of lung cancer patients with inflammation-induced depression and may be useful in predicting response to treatments that target inflammation or its downstream mediators on the brain.
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Affiliation(s)
- Daniel C McFarland
- Division of Network Services, Department of Medicine, Memorial Sloan Kettering Cancer Center, West Harrison, New York
| | - Kelly Shaffer
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, New York
| | - Andrew H Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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19
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McAndrew LM, Martin JL, Friedlander M, Shaffer K, Breland J, Slotkin S, Leventhal H. The Common Sense of Counseling Psychology: Introducing the Common-Sense Model of Self-Regulation. Couns Psychol Q 2017; 31:497-512. [PMID: 31274964 DOI: 10.1080/09515070.2017.1336076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of therapy is typically to improve clients' self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving client's self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal's Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we propose it may also be useful to understand self-management of mental health problems. The Common-Sense Model's strengths-based perspective is a natural fit for the work of counseling psychologists. In particular, the model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.
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Affiliation(s)
- Lisa M McAndrew
- Department of Educational and Counseling Psychology, University at Albany War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Healthcare System
| | - J L Martin
- Department of Educational and Counseling Psychology, University at Albany
| | - M Friedlander
- Department of Educational and Counseling Psychology, University at Albany
| | | | - J Breland
- Veterans Affairs Palo Alto Health Care System
| | - S Slotkin
- Department of Educational and Counseling Psychology, University at Albany
| | - H Leventhal
- Institute of Health, Health Care Policy and Aging Research, Rutgers University
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20
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Carr RA, Roch AM, Shaffer K, Aboudi S, Schmidt CM, DeWitt J, Ceppa EP, House MG, Zyromski NJ, Nakeeb A, Schmidt CM. Smoking and IPMN malignant progression. Am J Surg 2016; 213:494-497. [PMID: 28129918 DOI: 10.1016/j.amjsurg.2016.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/29/2016] [Accepted: 10/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with intraductal papillary mucinous neoplasm (IPMN) are at risk for invasive pancreatic cancer. We aim to characterize the impact of smoking on IPMN malignant progression. METHODS Patients undergoing pancreatic resection for IPMN (1991-2015) were retrospectively reviewed using a prospectively collected database. RESULTS Of 422 patients identified, 324 had complete data for analysis; 55% were smokers. Smoking status did not impact IPMN malignant progression (smokers/non-smokers: 22%/18% invasive grade; p = 0.5). Smokers were younger than non-smokers at the time of IPMN diagnosis (63 versus 68 years; p = 0.001). This association also held in the invasive IPMN subgroup (65 versus 72 years, p = 0.01). Despite this observation, rate of symptoms at diagnosis, cancer stage, and median survival were the same between smokers and non-smokers. CONCLUSION Although smoking is not associated with IPMN malignant progression, invasive IPMN is diagnosed at a younger age in smokers. These data suggest tobacco exposure may accelerate IPMN malignant progression.
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Affiliation(s)
- R A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K Shaffer
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S Aboudi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C M Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J DeWitt
- Department of Medicine, Division of Gastroenterology, Indiana University Hospital, Indianapolis, IN, USA
| | - E P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C M Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Janicek MJ, Demetri G, Janicek MR, Shaffer K, Fauci MA. Dynamic Infrared Imaging of Newly Diagnosed Malignant Lymphoma Compared with Gallium-67 and Fluorine-18 Fluorodeoxyglucose (FDG) Positron Emission Tomography. Technol Cancer Res Treat 2016; 2:571-8. [PMID: 14640768 DOI: 10.1177/153303460300200609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Staging and therapy monitoring of malignant lymphomas relies heavily on imaging using arbitrary size criteria from computed tomography (CT) and sometimes non-specific radionuclide studies to assess the activity of the disease. Treatment decisions are based on early assessment of the response to therapy and the residual volume of the disease. Our initial experience is reported using a new noninvasive, inexpensive, and reproducible passive imaging modality, Dynamic Infrared Imaging (DIRI), which may add a new dimension to functional imaging. This system relies on its ability to filter the raw infrared signal using biological oscillatory behavior. It detects and analyzes minute oscillations of temperature and heat distribution in tumors.
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Affiliation(s)
- M J Janicek
- Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Morag E, Lieberman G, Volkan K, Shaffer K, Novelline R, Lang EV. Clinical competence assessment in radiology: introduction of an objective structured clinical examination in the medical school curriculum. Acad Radiol 2001; 8:74-81. [PMID: 11201460 DOI: 10.1016/s1076-6332(03)80746-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES Traditional oral and written examinations can be limited in predicting future clinical performance. Therefore Objective Structured Clinical Examinations (OSCEs) have been introduced in other specialties. The authors assessed their value in radiology. MATERIALS AND METHODS The study includes 122 Harvard medical students who undertook 1-month compulsory clerkships at one of three hospitals (A, B, or C) in their 3rd and 4th year and a compulsory OSCE in their 4th year. The OSCE was constructed from five cases. Each had eight or nine standardized questions designed to test, within a set time, the perception of essential findings, their interpretation, and clinical judgment (maximum possible score, 100). Clerkship grades were high honors (score of 3), honors (score of 2), satisfactory (score of 1), and fail (score of 0). Predictors of OSCE scores-clerkship grade and affiliated hospital-were modeled as linear functions. Time elapsed between clerkship and OSCE was modeled as a nonlinear function. RESULTS Although there was a positive relation between clerkship grade and OSCE grade, it accounted for an increase of only 5.7% in OSCE score per clerkship grade and did not predict performance of individual students. Students who trained in hospital B showed significantly higher OSCE grades. OSCE scores were highest when the examination was taken 8 months after the clerkship. CONCLUSION The OSCE may be useful to uncover deficits in individuals and groups beyond the ones detected with traditional clerkship evaluations and provide guidance for remediation. The improved performance after additional clinical exposure suggests that the OSCE may be well suited to test the integration of radiologic and clinical knowledge.
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Affiliation(s)
- E Morag
- Harvard Medical School and the Department of Radiology at the Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to collect demographic information about radiology departments and rewards for teaching activities, as well as the impact of new digital imaging methods on teaching. MATERIALS AND METHODS Two surveys were conducted of directors of medical school clerkships in radiology. The initial survey focused on numbers of staff and students, courses taught, and perception of rewards for teaching. The follow-up survey more specifically addressed teaching methods. RESULTS Sixty-nine (50%) of the initial surveys sent to 139 departments and 46 (39% of a total of 119) of the follow-up surveys were returned. Clerkship directors spent an average of 9 hours per week teaching and performing administrative tasks, with most given no additional time off. Eighty-four percent of departments provide either no or insignificant rewards for teaching. Many departments have integrated the use of computers in teaching, and most have computers that students use during the radiology course. At the same time, digital imaging and picture archiving and communication systems (PACS) are used, or will be used within 1 year, in most departments. CONCLUSION Clerkship directors receive little compensation in terms of time and rewards for medical student teaching. Teaching methods are evolving in response to the increasing use of computers, digital imaging, and PACS for at least part of the workload in most radiology departments.
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Affiliation(s)
- S Samuel
- Department of Radiology, Brigham and Women's Hospital, Boston, Mass, USA
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Affiliation(s)
- M J Janicek
- Department of Radiology, Harvard Medical School, and the Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, Massachusetts 02115, USA.
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Abstract
Both imaging and image-directed biopsy play a major role in evaluating solitary pulmonary nodules. Imaging is used to determine whether the nodule is actually solitary or if multiple nodules are present. Once a nodule has been detected, imaging techniques can be used to characterize the nodule in terms of whether it is likely benign or malignant. As technology has improved, smaller nodules are now more easily detected, which may create a management dilemma. With the advent of video-assisted thoracoscopic techniques, however, sampling of these lesions has become much easier. Once a solitary pulmonary nodule is detected, image-guided biopsy is often considered, which can be undertaken using CT or fluoroscopy. Technical limitations, the location of the solitary pulmonary nodules, and clinical conditions must be considered when determining the role of image-guided biopsy. Other concerns include the role of on-site cytology and the use of more recent technical advances. Image-guided biopsy should be used as part of a multimodality approach to patient management, and decisions should be discussed with the radiologist and other caregivers to determine the cost-effectiveness and safety of the procedure for each patient.
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Affiliation(s)
- K Shaffer
- Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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26
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Stenger DA, Hickman JJ, Bateman KE, Ravenscroft MS, Ma W, Pancrazio JJ, Shaffer K, Schaffner AE, Cribbs DH, Cotman CW. Microlithographic determination of axonal/dendritic polarity in cultured hippocampal neurons. J Neurosci Methods 1998; 82:167-73. [PMID: 9700689 DOI: 10.1016/s0165-0270(98)00047-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 4.9] [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: 11/16/2022]
Abstract
High resolution substrates, created using patterned self-assembled monolayers, are shown to direct axonal and dendritic process extension at the level of a single hippocampal neuron. Axons and dendrites were identified using morphological characteristics and immunocytochemical markers. Patterns were formed on glass coverslips from a co-planar monolayer of cell adhesive aminosilanes and non-adhesive fluorinated silanes. On patterned surfaces, the percentage of the total number of cells attached to the 0.71 mm2 substrate field with compliance to the 25-micron diameter 'somal adhesion site' reached 41 +/- 7% (mean +/- S.D., 428 cells counted). A total of 76 +/- 11% of cells that adhered to a somal attachment site developed a lone process > or = 100 microns oriented in the direction of the continuous aminosilane pathway which was shown to express axonal markers. Cells on either the fluorinated silane, which is non-permissive for neurite outgrowth, or localized on an aminosilane region only 5 microns wide failed to extend major processes. This approach is amenable to a variety of industry standard fabrication techniques and may be used to study the role of fine scale spatial cues in neuronal development and synapse formation.
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Affiliation(s)
- D A Stenger
- Center for Bio/Molecular Science and Engineering, Naval Research Laboratory, Washington, DC 20375, USA.
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Smith D, Shaffer K, Kirn D, Canellos GP, Mauch PM, Shulman LN. Mediastinal large cell lymphoma: prognostic significance of CT findings at presentation and after treatment. Oncology 1998; 55:284-8. [PMID: 9663416 DOI: 10.1159/000011864] [Citation(s) in RCA: 8] [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: 11/19/2022]
Abstract
OBJECTIVE Primary mediastinal large cell lymphoma is a distinctive subtype of non-Hodgkin's lymphoma. Computed tomography (CT) has become an integral part of the evaluation of these patients at presentation and after completion of therapy. The purpose of this study is to identify CT features that predict increased risk of relapse. METHODS A retrospective study of patients with primary mediastinal large cell lymphoma who underwent CT scans of the thorax. RESULTS Tumor volume greater than 100 ml after completion of therapy was a statistically significant predictor of increased risk of relapse (p=0.02, Fisher exact test). Other measurements (obtained at presentation and after completion of treatment) were not statistically significant in predicting relapse. CONCLUSION CT plays an important role in predicting outcome in primary mediastinal large cell lymphoma. Large residual tumor volume after completion of treatment predicts an increased risk of relapse.
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Affiliation(s)
- D Smith
- Department of Radiology, Brigham and Women's Hospital, Boston, Mass 02155, USA.
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28
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Labi ML, Brentjens M, Shaffer K, Weiss C, Zielezny MA. Functional Cognition Index(C): A New Instrument to Assess Cognitive Disability After Traumatic Brain Injury. Neurorehabil Neural Repair 1998. [DOI: 10.1177/154596839801200201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Abstract
We present the imaging findings in 13 patients with nonmyxomatous primary neoplasms of the heart and pericardium. Ten patients had abnormal chest films. While echocardiography was useful for determining origin of the tumor, CT (computed tomography) and MRI (magnetic resonance imaging) were better at delineating extent of disease. The radiographic appearance of these rare neoplasms of the heart and pericardium is varied. Cross-sectional imaging plays a crucial role in the surgical planning and management of these patients.
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Affiliation(s)
- D N Smith
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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30
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Abstract
A key precipitating factor in the pathogenesis of acute bacterial sinusitis (ABS) is ostiomeatal obstruction. It has been postulated that ABS cannot resolve until the sinus ostium is patent. The primary purpose of this study is to quantify sinusitis resolution after temporary ostial occlusion in a rabbit model. A secondary aim is to quantify bacterial clearance with and without antimicrobial therapy in Staphylococcus aureus infected sinuses. A blinded, placebo controlled study in 10 New Zealand white rabbits was performed using Merocel as a temporary maxillary sinus ostial obstruction. Computerized tomography (CT) of the maxillary sinuses was obtained before and after bilateral ostial occlusion; sinuses were cultured and then the left sinus was injected with approximately 10(8) cfu/mL S. aureus. CT imaging and sinus cultures were obtained and then the ostial plugs were removed. Serial CT and cultures were done until sinusitis resolved and cultures were negative for S. aureus. Mean CT sinusitis scores increased with ostial obstruction and decreased with ostial plug removal (P < 0.0001 and P < 0.001). Injection of S. aureus did not significantly change mean CT sinusitis scores despite being cultured from 45% of sinuses. Antimicrobial therapy was not significant in reducing mean CT scan sinusitis scores or positive cultures. Resolution of mucosal swelling is more dependent on relief of ostial obstruction rather than antimicrobial therapy in this rabbit model.
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Affiliation(s)
- D J Beste
- Department of Otolaryngology and Human Communication, Medical College of Wisconsin, Milwaukee 53226, USA
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Abstract
Radiology and surgery are not competing but are complementary modalities in the care of patients with lung cancer. In certain areas, such as evaluation of the solitary pulmonary nodule, radiologic studies can have an important impact on patient care. Mediastinal staging with imaging studies is inexact, and CT may be most effective as a road map for more definitive surgical staging. MRI currently offers no advantages over CT in staging of the mediastinum but can be helpful in evaluation of parts of the chest not well demonstrated on axial images. A discussion of newer nuclear medicine imaging modalities is included.
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Affiliation(s)
- K Shaffer
- Department of Oncoradiology, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA 02115, USA
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32
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Abstract
Chest radiography and CT scanning remain the backbone of imaging of lung cancer, and they continue to play a pivotal role in staging. This role is best defined as providing a roadmap to oncologists and surgeons to assist in definitive pathologic staging, rather than as competing with these methods. Much more sensitive and specific imaging tools must be developed before noninvasive radiologic staging can replace surgical staging. New nuclear medicine techniques including PET scanning and use of monoclonal antibodies linked to radionuclides offer the best hope for such definitive radiologic staging in the future.
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Affiliation(s)
- K Shaffer
- Harvard Medical School, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Shaffer K, Smith D, Kirn D, Kaplan W, Canellos G, Mauch P, Shulman LN. Primary mediastinal large-B-cell lymphoma: radiologic findings at presentation. AJR Am J Roentgenol 1996; 167:425-30. [PMID: 8686620 DOI: 10.2214/ajr.167.2.8686620] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Primary mediastinal large-B-cell lymphoma was recently reclassified as a distinct clinical entity. We wished to review the imaging findings for this disease and to compare the findings with those for other disorders with a similar appearance. MATERIALS AND METHODS We retrospectively reviewed plain films, gallium scintigrams, MR images, and CT scans for 43 patients with primary mediastinal large-B-cell lymphoma. RESULTS All but one lesion arose in the anterior mediastinum. Areas of fluid attenuation within the masses were evident on CT scans in 50% of cases. Pleural effusions were seen by chest radiography in 33% of patients. Pericardial effusions were present in 32% of patients who underwent CT scans. Of the 21 patients who underwent gallium scintigraphy, all were reported to have positive findings. Also, MR imaging showed evidence of superior vena cava syndrome in one patient. CONCLUSION Primary mediastinal large-B-cell lymphoma typically is seen as a bulky anterior mediastinal mass that often contains areas of necrosis.
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Affiliation(s)
- K Shaffer
- Department of Radiology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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DiPiro PJ, Meyer JE, Shaffer K, Denison CM, Frenna TH, Rolfs AT. Usefulness of the routine magnification view after breast conservation therapy for carcinoma. Radiology 1996; 198:341-3. [PMID: 8596828 DOI: 10.1148/radiology.198.2.8596828] [Citation(s) in RCA: 8] [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: 01/31/2023]
Abstract
PURPOSE To assess the usefulness of the routine supplementary magnification view in patients who have undergone breast conservation therapy. MATERIALS AND METHODS Four hundred seventy-one mammograms in 392 patients were evaluated. Conventional craniocaudal and mediolateral oblique views were obtained in each patient. After a preliminary interpretation was made, a magnification view of the excision site was evaluated and any additional information was documented. RESULTS In 115 examinations (24%), the magnification view was considered necessary to better evaluate equivocal or questionable calcifications seen on standard views. In 18 cases (4%), review of the magnification view influenced the decision to perform biopsy. None of the magnification views that were considered unnecessary caused the interpretation made from conventional views to be altered. CONCLUSION Magnification mammographic views should be obtained in patients who have undergone breast conservation therapy only when considered necessary after review of findings on conventional views.
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Affiliation(s)
- P J DiPiro
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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35
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Beard CJ, Kijewski P, Bussière M, Gelman R, Gladstone D, Shaffer K, Plunkett M, Castello P, Coleman CN. Analysis of prostate and seminal vesicle motion: implications for treatment planning. Int J Radiat Oncol Biol Phys 1996; 34:451-8. [PMID: 8567348 DOI: 10.1016/0360-3016(95)02081-0] [Citation(s) in RCA: 198] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To quantify prostate and seminal vesicle positional changes (target motion) between treatment planning and delivery, and to identify the factors contributing to target motion. METHODS AND MATERIALS Thirty patients with adenocarcinoma of the prostate were prospectively evaluated by analyzing two sequential planning computerized tomography (CT) scans (S1, obtained prior to treatment, and S2, obtained during the fourth week of treatment) for each patient. All anatomical volumes of interest (soft tissue and bony) were reconstructed from transverse CT images and projected onto anterior and lateral beam's-eye view projections. Positional changes between S1 and S2 were eliminated by applying a rigid body translation and rotation. Target motion was then measured by recording the positional change between S1 and S2 at the edges (right, left, superior, inferior). Potential correlation of target motion with bladder volume, rectal volume, and rectal diameter changes were evaluated by linear regression analysis. RESULTS Neither the prostate nor seminal vesicles remained fixed with respect to bony anatomy between S1 and S2. The distribution of positional changes were generally small (< 0.5 cm), but maximum displacements of 1.5-2.2 cm did occur, particularly in the lateral view. In this study, bladder volume changes between the scans were small and did not correlate with target motion (P = 0.67). Both rectal volume and rectal diameter changes correlated with target motion for both the prostate (p = 0.004 and 0.005, respectively) and seminal vesicles (p < 0.001 and < 0.001, respectively). However, neither the initial rectal volume nor the initial rectal diameter could be used to predict subsequent target motion when evaluated either singly or as part of a multiple regression model. CONCLUSIONS Target motion occurs during the course of treatment planning and delivery and should be considered when designing conformal radiation fields. Although the target position at the time of planning CT may differ substantially from the mean treatment position, target motion cannot be predicted by evaluating simply measured parameters from a single scan, or double scan sequence.
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Affiliation(s)
- C J Beard
- Joint Center for Radiation Therapy, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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36
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Janicek MJ, Shaffer K. Scintigraphic and radiographic patterns of skeletal metastases in breast cancer: value of sequential imaging in predicting outcome. Skeletal Radiol 1995; 24:597-600. [PMID: 8614859 DOI: 10.1007/bf00204859] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether temporal changes in scintigraphic and bone radiographic findings have prognostic significance in patients with skeletal metastases from breast cancer. DESIGN Clinical information and films were retrospectively reviewed in 101 randomly selected patients with skeletal metastases. Images from sequential bond scans and bone radiographs were correlated with survival after detection of the metastases. RESULTS Time to detection of skeletal metastases and the length of time for which patients were classified as radiologically stable after development of skeletal metastases correlated with survival (r = 0.843; r = 0.821, respectively). Failure to develop a radiographically and scintigraphically stable pattern after treatment was associated with significantly decreased survival compared with the rest of the patients (mean survival 2.1 +/- 1.3 years vs 4.3 +/- 2.3 years; p < 0.001). Scintigraphic regression of metastases was associated with significant survival benefit and longer stabilization of disease compared to all other patterns (mean survival 5.0 +/- 2.7 years of regressive disease vs 3.7 +/- 1.9 years for stable disease and 2.2 +/- 1.3 years for progressive disease; p < 0.001). CONCLUSIONS Sequential scintigraphic and radiographic imaging is useful in breast cancer patients not only for detection of metastases and monitoring of treatment effect, but also because these studies provide valuable prognostic information.
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Affiliation(s)
- M J Janicek
- Department of Radiology, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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Abstract
OBJECTIVE In response to anecdotal reports of grave deterioration in the job market for graduates of radiology training programs, the American College of Radiology undertook a systematic appraisal of this job market for 1994. MATERIALS AND METHODS Between mid-April and mid-May 1994, the American College of Radiology surveyed 40 directors of randomly chosen diagnostic radiology training programs and 20 directors of randomly chosen radiation oncology training programs. We achieved a response rate of 80% or more in both categories. The survey asked, among other questions, the number of graduates, how many had jobs, the number of offers received by graduates this year and last, and how difficult the job market was relative to recent years. RESULTS Directors reported that 96% of graduating residents and 86% of graduating diagnostic fellows had commitments for positions. Of those with commitments, 94% of residents and 84% of diagnostic fellows were reported to have jobs that reasonably matched their training and job goals. Program directors estimated that the average graduate received two job offers but, on average, rated the job market as somewhat more difficult than was typical of recent years and reported that 1993 graduates had received more job offers. Plans to change size were reported for one fourth of programs, but the job market situation was not an important reason for these planned changes. CONCLUSION Although the overwhelming majority of 1994 graduates obtained jobs, and these overwhelmingly were jobs of interest, program directors reported that the job market was weakening. Given the changes in the socioeconomic environment--managed care, for example--and the changing job market, training programs should give more attention to the job market in planning for changes in size.
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Affiliation(s)
- J Sunshine
- Research Department, American College of Radiology, Reston, VA 22091
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38
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Seltzer SE, Kelly P, Adams DF, Chiango BF, Viera MA, Fener E, Rondeau R, Kazanjian N, Laffel G, Shaffer K. Expediting the turnaround of radiology reports: use of total quality management to facilitate radiologists' report signing. AJR Am J Roentgenol 1994; 162:775-81. [PMID: 8140990 DOI: 10.2214/ajr.162.4.8140990] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether total quality management techniques could be used to speed radiologists' performance on the task of signing reports. SUBJECTS AND METHODS Total quality management represents a group of tools that can be used to improve the functioning of complex processes in the workplace. The steps involved in our total quality management project were as follows: (1) commit to improving radiologists' performance, (2) commission an interdisciplinary study team, (3) propose hypotheses for the causes of signing delays, (4) identify the key issues constraining performance (Pareto analysis), (5) intervene to correct systematic problems in a test system, (6) evaluate the results of intervention on radiologists' report signing performance, and (7) hold the gains achieved by the intervention. An interdisciplinary study team identified five key obstacles to prompt signing of reports: (1) radiologists' absence from the department when reports were available for signing (e.g., nights and weekends), (2) dysfunctional hand-off between transcriptionist and radiologist, (3) requirement that a fellow or resident sign before a staff radiologist, (4) lack of a system for signing by proxy (if primary radiologist is away), (5) perceived lack of impact of signed report on clinical decision making. RESULTS Interventions included (1) providing home computer terminals, (2) implementing a buddy system for proxy signing, (3) eliminating the requirement for a signature from a fellow or resident, (4) teaming groups of radiologists with specific transcriptionists, and (5) streamlining transcription service. When these enhancements were used in a test system, the mean time required to sign reports decreased 59% from 26.0 +/- 8.4 hr (mean +/- standard error) in the baseline period to 10.6 +/- 2.9 hr (in the enhanced period, p = .05). CONCLUSION We conclude that total quality management methods can accelerate radiologists' signing of reports.
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Affiliation(s)
- S E Seltzer
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115
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Abstract
OBJECTIVE Lymphangiomas are rare benign tumors most often seen in childhood. When they occur in adults, radiologic diagnosis can be difficult. A retrospective study of the CT and MR appearances of thoracic lymphangiomas in adult patients was performed in order to describe the range of radiologic features of these tumors. MATERIALS AND METHODS Cases of adult lymphangioma at three institutions were identified in the records of 19 patients, predominantly female, 18-67 years old. RESULTS The most common CT appearance was a smoothly marginated cystic mass. Unusual features included calcification, spiculated margins, and homogeneous soft-tissue attenuation. The majority of cases were located in the anterior or superior mediastinum. Unusual locations included the pericardium, pulmonary hilum, and pulmonary parenchyma. Signal characteristics on MR images varied. CONCLUSION The radiographic appearance of lymphangiomas in the chest in adult patients is varied. The diagnosis cannot be suggested on the basis of radiologic studies alone.
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Affiliation(s)
- K Shaffer
- Department of Radiology, Dana Farber Cancer Institute, Boston, MA 02115
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40
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Kirn D, Mauch P, Shaffer K, Pinkus G, Shipp MA, Kaplan WD, Tung N, Wheeler C, Beard CJ, Canellos GP. Large-cell and immunoblastic lymphoma of the mediastinum: prognostic features and treatment outcome in 57 patients. J Clin Oncol 1993; 11:1336-43. [PMID: 8315431 DOI: 10.1200/jco.1993.11.7.1336] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE A retrospective study was performed to define clinical characteristics and therapeutic outcome for patients with large-cell and immunoblastic lymphoma of the mediastinum. PATIENTS AND METHODS Fifty-seven patients who presented with primary, mediastinal large-cell and immunoblastic lymphoma were retrospectively studied to determine initial sites of disease, radiologic characteristics, treatment, outcome, and factors that have prognostic significance for progression-free and overall survival. RESULTS Fifty-six of the 57 patients had disease that was confined to sites above the diaphragm. Bulky disease and extensive intrathoracic infiltration were common in these patients. All patients were treated with intensive chemotherapy regimens, and 44% of patients received chest irradiation. The overall 5-year survival by Kaplan-Meier estimation was 50% with a freedom-from-relapse rate of 45%. Predictors of disease relapse after chemotherapy included the presence of a pleural effusion (P = .015), a number of involved extranodal sites (P < .01), and a lactic dehydrogenase (LDH) ratio > 3.0 (LDH value/upper limit of assay; P = .04) as well as an incomplete treatment response as evidenced by residual mass on chest radiograph (P = .02) or persistent gallium 67 avidity (P = .01) after chemotherapy. Predictors of decreased survival included the presence of pleural effusion (P = .001), the number of involved extranodal sites (P = .022), and a positive posttreatment 67Ga scan (P = .027). CONCLUSION Patients with primary mediastinal large-cell and immunoblastic lymphoma have an approximate 50% chance of surviving disease-free after initial therapy. The presence of pleural effusion at presentation was associated with an extremely poor outcome. Bulk disease per se was a negative predictive factor only in patients without pleural effusions when compared with patients who did not have bulk disease. In addition, all patients with involvement of two or more extranodal sites relapsed when treated with standard chemotherapy.
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Affiliation(s)
- D Kirn
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115
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Barr LL, Shaffer K, Valley K, Hillman BJ. Mentoring. Applications for the practice of radiology. Invest Radiol 1993; 28:71-5. [PMID: 8425857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- L L Barr
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899
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Patz EF, Shaffer K, Piwnica-Worms DR, Jochelson M, Sarin M, Sugarbaker DJ, Pugatch RD. Malignant pleural mesothelioma: value of CT and MR imaging in predicting resectability. AJR Am J Roentgenol 1992; 159:961-6. [PMID: 1414807 DOI: 10.2214/ajr.159.5.1414807] [Citation(s) in RCA: 128] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Our objective was to determine if CT or MR imaging findings could be used to accurately predict resectability in patients with biopsy-proved malignant pleural mesotheliomas. SUBJECTS AND METHODS CT and MR findings in 41 consecutive patients with malignant mesotheliomas who were referred to the thoracic surgery clinic for extrapleural pneumonectomy were studied by thoracic radiologists before surgery. Review of radiologic studies focused on local invasion of three separate regions: the diaphragm, chest wall, and mediastinum. Results of all imaging examinations were carefully correlated with intraoperative, gross, and microscopic pathologic findings. RESULTS After radiologic and clinical evaluation, 34 patients (83%) had thoracotomy; 24 of these had tumors that were resectable. The sensitivity was high (> 90%) for both CT and MR in each region. Specificity, however, was low, probably because of the small number of patients with unresectable tumors. CONCLUSION CT and MR provided similar information on resectability in most cases. Sensitivity was high for both procedures. Because CT is more widely available and used, we suggest it as the initial study when determining resectability. In difficult cases, important complementary anatomic information can be derived from MR images obtained before surgical intervention.
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Affiliation(s)
- E F Patz
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115
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43
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Stark P, Jacobson F, Shaffer K. Standard imaging in silicosis and coal worker's pneumoconiosis. Radiol Clin North Am 1992; 30:1147-54. [PMID: 1410305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Silicosis and coal worker's pneumoconiosis (CWP) are two relatively common occupational diseases. Silicosis is the most common pneumoconiosis in the United States. It results from inhalation of the particulate form of quartz or other crystalline forms of silicon dioxide with a diameter of less than 5 micrograms. CWP is the result of inhalation of carbon particles. Pathologic features of the two diseases differ, yet their radiologic features are identical. Simple pneumoconiosis is characterized by multiple small rounded opacities of 1 to 5 mm in diameter and with a bias for the upper lung zones. Complicated pneumoconiosis results from confluence of small opacities into large opacities that form conglomerate masses or progressive massive fibrosis.
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Affiliation(s)
- P Stark
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
From July 1, 1989, through June 30, 1991, 1,218 preoperative wire-localization breast biopsies were performed at one institution. In this group, 254 (21%) of the abnormalities were fibroadenomas, 26 of which had enlarged or developed in the interval between routine or short-interval follow-up mammography. This interval growth was noted in 21 premenopausal women and in five who were postmenopausal and receiving oral estrogen supplementation.
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Affiliation(s)
- J E Meyer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
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45
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Abstract
During the 30-month period from March 1, 1988, through August 31, 1990, image-guided aspirations of 183 solitary occult breast masses, which were considered possible cysts, were performed. Indications for aspiration included (1) mass on mammography, either invisible on ultrasonography or with features atypical of a cyst, in 111 patients; (2) enlarging solitary mass on mammography with ultrasonic features suggesting a cyst in 45 patients; and (3) mammographic mass with features typical of a cyst in 27 patients, with confirmation requested by the referring physician. Of the group, 151 (83%) lesions were fluid-filled and 32 (17%) were solid. All aspirates had normal cytologic features. Of the 32 aspirates found to be solid, 19 were subsequently removed after wire localization and 13 were unchanged on mammography for a minimum of 6 months after aspiration. This is a simple and safe procedure, confirming the innocuous nature of an occult solitary breast cyst, and obviates the need for surgical biopsy.
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Affiliation(s)
- J E Meyer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115
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Abstract
An elderly woman was seen with a left mediastinal mass in the region of the aortic arch on chest roentgenography. Further imaging with computed tomography, angiography, and magnetic resonance demonstrated a highly vascular neoplasm adjacent to the aortic arch. Pathological analysis of the resected specimen showed a leiomyoma. A brief review of the 10 previous reported cases of primary mediastinal leiomyoma is provided.
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Affiliation(s)
- K Shaffer
- Division of Thoracic Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts 02115
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Abstract
Small pulmonary nodules can be difficult to examine with routine computed tomographic techniques, primarily because of inconsistent levels of inspiration on sequential scans. However, with the patient performing a breathing technique that involves three rapid maximal inspirations and expirations followed by a final maximal inspiration, an average of six images that cover a 12-mm section of lung can be obtained during a single breath. The technique has been used in 10 patients, with encouraging results.
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Affiliation(s)
- K Shaffer
- Division of Thoracic Radiology, Brigham and Women's Hospital, Boston, MA 02115
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Abstract
A prototype 5,000-word recognizer for the generation of radiologic reports by voice entry was evaluated. The system had a capacity sufficient enough to include all radiologic examinations and all desired words in one lexicon. The lack of such a capacity had been identified as a major limitation of a 1,000-word system previously evaluated. Overall reliability in word recognition was 98%. The device may be widely applicable for use in any radiology practice.
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Affiliation(s)
- A H Robbins
- Department of Radiology, Boston Veterans Administration Medical Center, MA 02130
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Abstract
Voice entry has been successfully employed to generate radiology reports with a word recognizer with a 1,000-word lexicon capacity. About 50% of reports were able to be dictated with a single 900-word lexicon. This was split into five sections by anatomic or subspecialty application. Each was augmented to 900 words. By switching from one lexicon to another, it was possible to dictate more than 70% of reports. With exclusive use of three lexicons in subspecialty areas (gastrointestinal radiology, neuroradiology, and mammography), and with further modification of the respective vocabulary, it has been possible to employ the system 88% of the time. Twelve percent of cases included wording that was beyond the scope of the lexicon. Computer subsets that allow different translations of some words when used in different contexts have been used. Some of these are used as triggers that will print whole lines, sentences, or even complete reports. Dictation times with voice entry take about 20% longer. Recognition reliability has been greater than 95%.
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Klein HA, Shaffer K. Aging and memory in skilled language performance. J Genet Psychol 1985; 146:389-97. [PMID: 3834044 DOI: 10.1080/00221325.1985.9914467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The issue of irreversible decrements versus developmental plasticity with aging was explored for skilled language users. Fifteen English teachers (22 to 31 years of age) and 15 retired English teachers (50 to 83 years of age) were tested for language memory, using a 2 X 2 X 2 (Recall vs. Recognition X Meaningful vs. Nonmeaningful X Incidental vs. Intentional) design, and for overall grammar-skill memory, using speed and error measures. On the language-memory test, experimental variables (but not the age variable) were related to performance. On the grammar-skill test, the older subjects showed longer completion times but no decrements in accuracy. The results provided support for developmental plasticity in language memory and suggested an optimistic view of memory for skilled content areas.
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