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Parvez E, Bogach J, Kirkwood D, Pond G, Doumouras A, Hodgson N, Levine M. ASO Visual Abstract: Immigration Status and Breast Cancer Surgery Quality of Care Metrics: A Population-Level Analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15376-9. [PMID: 38734864 DOI: 10.1245/s10434-024-15376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Affiliation(s)
- E Parvez
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Escarpment Cancer Research Institute, Hamilton, ON, Canada.
| | - J Bogach
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - G Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - A Doumouras
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- ICES McMaster, Hamilton, ON, Canada
| | - N Hodgson
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - M Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
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Parvez E, Bogach J, Kirkwood D, Pond G, Doumouras A, Hodgson N, Levine M. Immigration Status and Breast Cancer Surgery Quality of Care Metrics: A Population-Level Analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15250-8. [PMID: 38637444 DOI: 10.1245/s10434-024-15250-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION As immigrant women face challenges accessing health care, we hypothesized that immigration status would be associated with fewer women with breast cancer receiving surgery for curable disease, fewer undergoing breast conserving surgery (BCS), and longer wait time to surgery. METHODS A population-level retrospective cohort study, including women aged 18-70 years with Stage I-III breast cancer diagnosed between 2010 and 2016 in Ontario was conducted. Multivariable analysis was performed to assess odds of undergoing surgery, receiving BCS and wait time to surgery. RESULTS A total of 31,755 patients were included [26,253 (82.7%) Canadian-born and 5502 (17.3%) immigrant women]. Immigrant women were younger (mean age 51.6 vs. 56.1 years) and less often presented with Stage I/II disease (87.4% vs. 89.8%) (both p < .001). On multivariable analysis, there was no difference between immigrant women and Canadian-born women in odds of undergoing surgery [Stage I OR 0.93 (95% CI 0.79-1.11), Stage II 1.04 (0.89-1.22), Stage III 1.22 (0.94-1.57)], receiving BCS [Stage I 0.93 (0.82-1.05), Stage II 0.96 (0.86-1.07), Stage III 1.00 (0.83-1.22)], or wait time [Stage I 0.45 (-0.61-1.50), Stage II 0.33 (-0.86-1.52), Stage III 3.03 (-0.05-6.12)]. In exploratory analysis, new immigrants did not have surgery more than established immigrants (12.9% vs. 10.1%), and refugee women had longer wait time compared with economic-class immigrants (39.5 vs. 35.3 days). CONCLUSIONS We observed differences in measures of socioeconomic disadvantage and disease characteristics between immigrant and Canadian-born women with breast cancer. Upon adjusting for these factors, no differences emerged in rate of surgery, rate of BCS, and time to surgery. The lack of disparity suggests barriers to accessing basic components of breast cancer care may be mitigated by the universal healthcare system in Canada.
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Affiliation(s)
- E Parvez
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - J Bogach
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - G Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - A Doumouras
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- ICES McMaster, Hamilton, ON, Canada
| | - N Hodgson
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - M Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
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Swaminath A, Parpia S, Wierzbicki M, Kundapur V, Faria S, Okawara G, Tsakiridis T, Ahmed N, Bujold A, Hirmiz K, Owen T, Leong N, Ramchandar K, Filion E, Lau H, Louie A, Quan K, Levine M, Wright J, Whelan T. LUSTRE: A Phase III Randomized Trial of Stereotactic Body Radiotherapy (SBRT) vs. Conventionally Hypofractionated Radiotherapy (CRT) for Medically Inoperable Stage I Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Philpot R, Liebst L, Rosenkrantz Lindegaard M, Verbeek P, Levine M. Reconciliation in human adults: a video-assisted naturalistic observational study of post conflict conciliatory behaviour in interpersonal aggression. BEHAVIOUR 2022. [DOI: 10.1163/1568539x-bja10176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Reconciliation is an aspect of conflict resolution, with similar behavioural patterns documented in non-human primates, human children, and human adults of non-Western, non-industrialized cultures. Reconciliation amongst adults of industrialized societies has rarely been studied. We observed naturally occurring conflicts between adults, captured by public security cameras in England. Reconciliation was found in one-quarter of all conflicts and was more prevalent in milder conflicts. Reconciliation typically occurred spontaneously between opponents — and was found within friendship groups and across stranger groups. Reconciliation between opponents also appeared to be stimulated by peers, law enforcement, or shared objects. In some instances, reconciliation extended beyond the initial conflict dyad toward victimized third-party peacemakers. These findings add to growing cross-cultural and cross-species evidence demonstrating the presence and function of post-conflict reconciliation. We extend the repertoire of reconciliatory behaviour and introduce five common features of reconciliation that are central to the study of adult peacemaking.
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Affiliation(s)
- R. Philpot
- Department of Psychology, Lancaster University, Bailrigg, Lancaster LA1 4YF, UK
| | - L.S. Liebst
- Department of Sociology, University of Copenhagen, Øster Farimagsgade 5, Building 16. 1014 Copenhagen K, Denmark
| | - M. Rosenkrantz Lindegaard
- Department of Sociology, University of Copenhagen, Øster Farimagsgade 5, Building 16. 1014 Copenhagen K, Denmark
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), De Boelelaan 1077, 1081 HV Amsterdam, The Netherlands
| | - P. Verbeek
- Department of Anthropology, University of Alabama at Birmingham, University Hall, 1402 10th Avenue South – UH 3165, Birmingham, AL 35294-1241, USA
| | - M. Levine
- Department of Psychology, Lancaster University, Bailrigg, Lancaster LA1 4YF, UK
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Kim D, Theberge V, Provencher S, Yassa M, Kong I, Perera F, Lavertu S, Rousseau P, Lee J, Karam I, Schneider K, Chambers S, Levine M, Parpia S, Whelan T. OPAR: A Multicenter Phase II Randomized Trial of Fractionation Schedules for Once-a-Day Accelerated Partial Breast Irradiation (APBI). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.047] [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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ToxIC Fentalog Study Group, Levine M, Meyn A, Krotulski A, Logan B, Amaducci A, Hughes A, Schwarz E, Pizon A, Wax P, Brent J, Manini A. 71 Adulteration of Illicit Drugs in Emergency Department Patients With Acute Opioid Overdose: A Multicenter Cohort. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Enhancers switch genes on and off in response to a variety of intrinsic and external cellular signals. They are the cornerstone of gene regulation and the most pervasive constituents of the regulatory genome. Sequence polymorphisms in enhancer DNAs are a major source of population diversity and predilection to disease. To view this SnapShot, open or download the PDF.
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Affiliation(s)
- X Y Bing
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - P J Batut
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - M Levo
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - M Levine
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - J Raimundo
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
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Marshall A, Young A, Levine M, Hill C, Hale D, Thirlwall J, Wilkie V, French K, Kakkar A, Lokare A, Maraveyas A, Chapman O, Arif A, Petrou S, Maredza M, Hobbs F, Dunn J. PO-36 Treatment of cancer-associated venous thromboembolism: 12-month outcomes of the placebo versus rivaroxaban randomisation of the SELECT-D trial. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tsakiridis T, Pond G, Wright J, Ellis P, Abdulkarim B, Ahmed N, Robinson A, Valdes M, Okawara G, Swaminath A, Wierzbicki M, Levine M. Randomized Phase II Trial of Metformin in Combination with Chemoradiotherapy (CRT) in Locally Advanced Non-Small Cell Lung Cancer (LA-NSCLC); the OCOG-ALMERA trial (NCT02115464). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Krzyzanowska M, Julian J, Gu CS, Powis M, Li Q, Enright K, Howell D, Earle C, Gandhi S, Rask S, Brezden-Masley C, Dent S, Hajra L, Freedman O, Spadafora S, Hamm C, Califaretti N, Trudeau M, Levine M, Grunfeld E. LBA87 A pragmatic cluster-randomized trial of ambulatory toxicity management in patients receiving adjuvant or neo-adjuvant chemotherapy for early stage breast cancer (AToM). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Kuo PL, Schrack JA, Shardell MD, Levine M, Moore AZ, An Y, Elango P, Karikkineth A, Tanaka T, de Cabo R, Zukley LM, AlGhatrif M, Chia CW, Simonsick EM, Egan JM, Resnick SM, Ferrucci L. A roadmap to build a phenotypic metric of ageing: insights from the Baltimore Longitudinal Study of Aging. J Intern Med 2020; 287:373-394. [PMID: 32107805 PMCID: PMC7670826 DOI: 10.1111/joim.13024] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [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] [Indexed: 12/15/2022]
Abstract
Over the past three decades, considerable effort has been dedicated to quantifying the pace of ageing yet identifying the most essential metrics of ageing remains challenging due to lack of comprehensive measurements and heterogeneity of the ageing processes. Most of the previously proposed metrics of ageing have been emerged from cross-sectional associations with chronological age and predictive accuracy of mortality, thus lacking a conceptual model of functional or phenotypic domains. Further, such models may be biased by selective attrition and are unable to address underlying biological constructs contributing to functional markers of age-related decline. Using longitudinal data from the Baltimore Longitudinal Study of Aging (BLSA), we propose a conceptual framework to identify metrics of ageing that may capture the hierarchical and temporal relationships between functional ageing, phenotypic ageing and biological ageing based on four hypothesized domains: body composition, energy regulation, homeostatic mechanisms and neurodegeneration/neuroplasticity. We explored the longitudinal trajectories of key variables within these phenotypes using linear mixed-effects models and more than 10 years of data. Understanding the longitudinal trajectories across these domains in the BLSA provides a reference for researchers, informs future refinement of the phenotypic ageing framework and establishes a solid foundation for future models of biological ageing.
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Affiliation(s)
- P-L Kuo
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J A Schrack
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M D Shardell
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - M Levine
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - A Z Moore
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Y An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - P Elango
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - A Karikkineth
- Clinical Research Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - T Tanaka
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - R de Cabo
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - L M Zukley
- Clinical Research Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - M AlGhatrif
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.,Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - C W Chia
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - E M Simonsick
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - J M Egan
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - S M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - L Ferrucci
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
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Barraco F, Greil R, Herbrecht R, Schmidt HB, Reiter A, Willenbacher W, Raymakers R, Liersch R, Wroclawska M, Pack R, Burock K, Levine M, Gisslinger H. PF679 REAL-WORLD SAFETY DATA FROM A NONINTERVENTIONAL LONG-TERM POSTAUTHORIZATION SAFETY STUDY OF RUXOLITINIB IN MYELOFIBROSIS. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000561000.29259.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Abstract
BACKGROUND: Age is the biggest risk factor for developing breast cancer, which suggests that the biological aging process is a direct driver of cancer etiology. In all normal tissues, DNA methylation status changes systematically with age and is believed to mediate the biological consequences of aging. DNA methylation patterns, commonly referred to as 'Epigenetic Clocks', can be used as measures of aging. However, the chronologic and epigenetic ages can have subtle differences in different individuals. We hypothesize that accelerated epigenetic aging (i.e. DNA methylation indicating an older age than the chronologic age of the individual) is a risk factor for breast cancer development.
METHODS: We used DNA methylation data from blood samples and clinical data from n=2,107 participants in the Women's Health Initiative (WHI) and tested the association between breast cancer risk and two of the most commonly used epigenetic clocks by Horvath (based on 353 CpGs) and Hannum et al. (based on 71 CpGs). DNA methylation in whole blood was measured using the Illumina HumanMethylation450 BeadChip. We used Cox proportional hazard models to assess the association between two epigenetic age predictors (calculated using the algorithms by Horvath and Hannum et al.) and subsequent risk of breast cancer. The model was adjusted for several breast cancer risk factors including: chronologic age at the time of blood sampling, observational vs. clinical trial, clinical trial arm, race/ethnicity, education, BMI, waist-hip ratio, smoking, alcohol, age at menopause, age at menarche, number of pregnancies, age at first birth, previous mastectomy, months breastfed, and cell count estimates. Family history data and BRCA mutation status was incomplete in the WHI and therefore could not be included in our analysis.
RESULTS: Increased epigenetic age determined by the Horvath clock relative to chronological age was associated with increased future incidence of invasive breast cancer, even after adjusting for known risk factors (HR=1.04, P=0.03). Utilizing the Hannum clock, we found no significant association between epigenetic age and breast cancer risk (HR=1.01, P=0.568). When we included both age predictors as independent variables in a single model, the strength of the association between the Horvath epigenetic age and breast cancer risk increased (Horvath HR=1.09, P=6.3e-5; Hannum HR=0.95, p=0.077), such that every one year increase in epigenetic age relative to chronological age was associated with a 9% increased risk of future breast cancer. These results suggest that the aging signal in the Horvath clock that is unique from that captured by Hannum is what drives the specific association with breast cancer.
CONCLUSIONS: Our results support the hypothesis that “accelerated” epigenetic aging measured in the blood increases breast cancer risk. We also demonstrate that the two epigenetic clocks capture different aspects of aging, only some of which have implications for breast cancer risk. Epigenetic clocks may assist in targeting breast cancer screening to higher risk populations in the future, and understanding the biological mechanisms that are altered by the epigenetic changes may lead to new risk reduction strategies.
Citation Format: Hofstatter EW, Levine M, Hatzis C, Pusztai L. Age-related methylation signals of breast cancer risk in blood [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-05-01.
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Affiliation(s)
| | - M Levine
- Yale School of Medicine, New Haven, CT
| | - C Hatzis
- Yale School of Medicine, New Haven, CT
| | - L Pusztai
- Yale School of Medicine, New Haven, CT
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Murray MF, Evans JP, Angrist M, Uhlmann WR, Lochner Doyle D, Fullerton SM, Ganiats TG, Hagenkord J, Imhof S, Rim SH, Ortmann L, Aziz N, Dotson WD, Matloff E, Young K, Kaphingst K, Bradbury A, Scott J, Wang C, Zauber A, Levine M, Korf B, Leonard DG, Wicklund C, Isham G, Khoury MJ. A Proposed Approach for Implementing Genomics-Based Screening Programs for Healthy Adults. NAM Perspect 2018. [DOI: 10.31478/201812a] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joan Scott
- Health Resources and Services Administration
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15
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Levine M, Lu A, Quach A, Chen B, Baccarelli A, Whitsel E, Ferrucci L, Horvath S. AN EPIGENETIC CLOCK FOR AGING AND LIFE EXPECTANCY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Levine
- Yale School of Medicine, New Haven, Connecticut, United States
| | - A Lu
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - A Quach
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - B Chen
- LIFE Epigenetics, Los Angeles, CA, USA
| | - A Baccarelli
- Laboratory of Environmental Epigenetics, Departments of Environmental Health Sciences Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - E Whitsel
- Dept. of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - L Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, USA. Baltimore, MD, USA
| | - S Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Levine M. GENETIC AND EPIGENETIC CONTRIBUTIONS TO AGING AND DISEASE AMONG SMOKERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Levine
- Yale School of Medicine, New Haven, Connecticut, United States
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Levine M, Crimmins E, Horvath S, Ferrucci L. METHYLATION LANDSCAPES UNDERLYING HUMAN BIOLOGICAL AGING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Levine
- Yale School of Medicine, New Haven, Connecticut, United States
| | - E Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - S Horvath
- Department. of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - L Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, MD, USA
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Haghani A, Cacciottolo M, Doty K, Sioutas C, Town T, Morgan T, Levine M. CIGARETTES AND AIR POLLUTION SHOW CONVERGENT INTERACTIONS WITH APOE-SEX IN HUMANS AND MICE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Haghani
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, Los Angeles, California, United States
| | - M Cacciottolo
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - K Doty
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, United States
| | - C Sioutas
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - T Town
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, United States
| | - T Morgan
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - M Levine
- Yale School of Medicine, United States;. Caleb Finch, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
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Levine M, Cohen AA. ADVANCING GEROSCIENCE: NEW METHODS FOR GENOMIC EPIDEMIOLOGY OF AGING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Levine
- Yale School of Medicine, New Haven, Connecticut
| | - A A Cohen
- Universite de Sherbrooke, St-Denis-de-Brompton, Quebec
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Crimmins E, Faul J, Levine M. BIOMARKER DATA INNOVATIONS IN THE HEALTH AND RETIREMENT STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Crimmins
- University of Southern California, Los Angeles, CA, USA, Los Angeles, California
| | - J Faul
- University of Michigan, Ann Arbor, Michigan
| | - M Levine
- Yale School of Medicine, New Haven, Connecticut
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Levine M. Intentionally Designing Communities for Health and Well-Being: A Vision for Today. J Law Med Ethics 2018; 46:685-690. [PMID: 30336100 DOI: 10.1177/1073110518804228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Efforts in Virginia highlight an emerging approach to improving health and well-being for the population - human-centered design intentionally focused on protecting health and improving well-being. This keynote emphasized a data-informed approach facilitated by multi-sectoral leadership that promotes alignment of community assets focused to result in system changes more likely to sustainably improve health and well-being.
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Affiliation(s)
- Marissa Levine
- Marissa Levine, M.D., M.P.H., is Professor of Public Health at the University of South Florida College of Public Health. She is the former Commissioner, Virginia Department of Health. She received her M.D. from Albert Einstein College of Medicine, Bronx, NY and her M.P.H. from Johns Hopkins Bloom-berg School of Public Health, Baltimore, MD
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Wastiaux A, Levine M, Viard J, Matheron S, Girard T. Transition des adolescents infectés par le VIH par transmission mère–enfant : évaluation à 10 ans d’un modèle créé dans une structure hospitalière ambulatoire pour adolescents/jeunes adultes. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.367] [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: 10/14/2022]
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23
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Young A, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, Hale D, Dunn J, Kakkar A, Levine M. Anticoagulation Therapy in SELECTeD Cancer Patients at Risk of Recurrence of Venous Thromboembolism: Results of the ‘select-d’ Pilot Trial. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khoudigian-Sinani S, Blackhouse G, Levine M, Thabane L, O’Reilly D. The premarket assessment of the cost-effectiveness of a predictive technology "Straticyte™" for the early detection of oral cancer: a decision analytic model. Health Econ Rev 2017; 7:35. [PMID: 28971373 PMCID: PMC5624864 DOI: 10.1186/s13561-017-0170-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 09/21/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Approximately half of oral cancers are detected in advanced stages. The current gold standard is histopathological assessment of biopsied tissue, which is subjective and dependent on expertise. Straticyte™, a novel prognostic tool at the pre-market stage, that more accurately identifies patients at high risk for oral cancer than histopathology alone. This study conducts an early cost-effectiveness analysis (CEA) of Straticyte™ and histopathology versus histopathology alone for oral cancer diagnosis in adult patients. METHODS A decision-analytic model was constructed after narrowing the scope of Straticyte™, and defining application paths. Data was gathered using the belief elicitation method, and systematic review and meta-analysis. The early CEA was conducted from private-payer and patient perspectives, capturing both direct and indirect costs over a five-year time horizon. One-way and probabilistic sensitivity analyses were conducted to investigate uncertainty. RESULTS Compared to histopathology alone, histopathology with Straticyte™ was the dominant strategy, resulting in fewer cancer cases (31 versus 36 per 100 patients) and lower total costs per cancer case avoided (3,360 versus 3,553). This remained robust when Straticyte™ was applied to moderate and mild cases, but became slightly more expensive but still more effective than histopathology alone when Straticyte™ was applied to only mild cases. The probabilistic and one-way sensitivity analyses demonstrated that incorporating Straticyte™ to the current algorithm would be cost-effective over a wide range of parameters and willingness-to-pay values. CONCLUSION This study demonstrates high probability that Straticyte™ and histopathology will be cost-effective, which encourages continued investment in the product. The analysis is informed by limited clinical data on Straticyte™, however as more data becomes available, more precise estimates will be generated.
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Affiliation(s)
- S. Khoudigian-Sinani
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- PATH Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
- Health Research Methodology (HRM), specializing in Health Technology Assessment (HTA), Hamilton, Canada
| | - G. Blackhouse
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- PATH Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - M. Levine
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- PATH Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
- Research Institute of St. Joseph’s, Hamilton, ON Canada
- Centre of Evaluation of Medicines, Father Sean O’Sullivan Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Patented Medicine Prices Review Board (Canada), Ottawa, Canada
| | - L. Thabane
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- Research Institute of St. Joseph’s, Hamilton, ON Canada
- Department of Anesthesia/ Pediatrics, Faculty of Health Science, McMaster University, Hamilton, Canada
- Biostatistics Unit, St Joseph’s Healthcare, Hamilton, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - D. O’Reilly
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- PATH Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
- Research Institute of St. Joseph’s, Hamilton, ON Canada
- Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph’s Healthcare, Hamilton, Canada
- Early Researcher Award Recipient, Ministry of Research and Innovation, Toronto, Canada
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Levine M. EPIGENETIC AGE OF THE PRE-FRONTAL CORTEX AND ALZHEIMER’S DISEASE PATHOLOGY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M. Levine
- University of California, Los Angeles, Los Angeles, California
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Saito Y, Kim J, Levine M, Zhang Y, Crimmins E. SEX DIFFERENCES IN BIOLOGICAL AGE: JAPAN AND THE U.S. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J. Kim
- University of Southern California, Los Angeles, California,
| | - M. Levine
- University of California Los Angeles, Los Angeles, California
| | - Y. Zhang
- University of Southern California, Los Angeles, California,
| | - E.M. Crimmins
- University of Southern California, Los Angeles, California,
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Ratcliffe J, Hodgson N, Rana P, Forbes M, Levine M, Sussman J. Abstract P4-19-02: Young women with early stage breast cancer and their supportive care needs: Results from a regional survey. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-19-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Approximately 18% of all newly diagnosed breast cancer cases in Canada occur in women less than 50 years of age. Young women with breast cancer (YWBC) may experience unique physical and psycho-social issues yet there is a lack of data outlining their specific needs and concerns across the trajectory of care. This study described the unmet supportive care needs of YWBC at a regional cancer centre in southern Ontario, Canada.
Objectives
1. To describe unmet supportive care needs of young women (<45 years) with early stage breast cancer in a representative region by using the Supportive Cancer Needs Survey (SCNS-SF34).
2. To describe the level of satisfaction with information to support cancer treatment decision making and causes of distress among YWBC (<45 years) in a representative region.
Study Design
This study used a prospective survey design that was administered to consenting YWBC. The Supportive Care Needs Survey (SCNS-SF34) was used to measure respondents' need for cancer support and care. This instrument captures needs through 34-items that cover five domains: psychological needs, health system and informational needs, physical and daily living needs, patient care support needs and sexuality needs. In addition, an original 26-item survey questionnaire was administered. Survey items were developed from the recurring themes of an earlier project that informed 4 levels of inquiry: demographics, decision making/ informational support, disease and treatment characteristics, and causes of distress.
Results
Fifty-one patients were approached by a member of their circle of care. Of these patients, 35 completed the survey resulting in a 69% response rate. The majority of respondents were between the ages of 33 and 40 (48.6%), were diagnosed within 6 to 12 months of study entry (60.0%); had a university degree (51.4%); were married (82.9%) and (65.7%) have young children.
The three most common Moderate to High Unmet Supportive Care needs (rated 4 or 5 on a 5-point Likert scale) were: “Worries of those close to you” (34.3%), “Fears about the cancer spreading” (34.3%), “Anxiety” (28.6%) all of which reside in the psychological domain. Overall respondents agreed or strongly agreed to statements regarding their level of satisfaction with information to support cancer treatment decision making provided by their oncology team. Respondents did score lower in satisfaction with the information their oncology team provided regarding fertility. In terms of psychosocial support, 40% percent of respondents reported they had met with a social worker and 17% reported attending a breast cancer support group.
Conclusion
The results highlight that the supportive care needs of many YWBC are unmet, particularly those related to psychological burden and fertility concerns. Early identification and appropriate referral to fertility specialists and/or supportive care social workers could improve current practice. Further research is needed to explore how barriers to fertility and supportive care needs of young adults with cancer may best be overcome.
Citation Format: Ratcliffe J, Hodgson N, Rana P, Forbes M, Levine M, Sussman J. Young women with early stage breast cancer and their supportive care needs: Results from a regional survey [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-02.
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Affiliation(s)
- J Ratcliffe
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - N Hodgson
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - P Rana
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - M Forbes
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - M Levine
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - J Sussman
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, ON, Canada
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Abstract
A major portion of the toxic activity of plaque extracts to cells in culture is due to macromolecules which might be lymphotoxins derived from antigen or mitogen-activated lymphocytes in the gingiva. Assays of sensitivity to aL929 and HeLa cells, and of the effect of neutralizing antibody, indicated that the plaque toxins did not have the properties of the lymphotoxins. The results are consistent with other findings and suggest that the toxins are microbial exotoxins.
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Affiliation(s)
- M. Levine
- Department of Biochemistry and Molecular Biology, University of Oklahoma at Oklahoma City, Health Sciences Center, P.O. Box 26901, Oklahoma City, Oklahoma 73190
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Supiot S, Delaroche G, Latorzeff I, Magne N, Créhange G, Carrie C, Pommier P, Martin E, Bera G, Rio E, Paumier A, Martin J, Levine M, Julian J, Lukka H, Catton C. Profit (Prostate Fractionated Irradiation Trial) : résultats d’une étude internationale randomisée comparant deux schémas d’irradiation des cancers de prostate de risque intermédiaire. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.249] [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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Goldberg DS, Blumberg E, McCauley M, Abt P, Levine M. Improving Organ Utilization to Help Overcome the Tragedies of the Opioid Epidemic. Am J Transplant 2016; 16:2836-2841. [PMID: 27438538 PMCID: PMC5462444 DOI: 10.1111/ajt.13971] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/21/2016] [Accepted: 07/12/2016] [Indexed: 01/25/2023]
Abstract
Death rates from drug overdoses have nearly doubled since 2003, with over 47 000 deaths in 2014. This is largely attributable to the opioid epidemic. If the unfortunate deaths of otherwise healthy people have yielded an increase in organ donors, then this might serve as perhaps the only comforting factor among this tragic and unnecessary loss of life. In this viewpoint, we present data from the Organ Procurement and Transplantation Network (OPTN) that show how the greatest relative increases in the mechanism of death among deceased donors from 2003 to 2014 were drug overdoses. Unfortunately, despite the absolute increase in the number of donors who died from a drug overdose, the mean organ yield was significantly lower than in other categories, in part due to concerns about disease transmission. In this paper, we present data on the changes in donation from donors with a drug overdose as a result of the opioid epidemic and discuss the need to educate transplant candidates and their physicians about the low risk of disease transmission compared to the greater risk of dying on a transplant waitlist.
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Affiliation(s)
- D. S. Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA,Corresponding author: David Goldberg,
| | - E. Blumberg
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M. McCauley
- Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P. Abt
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA
| | - M. Levine
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA
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31
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Katzin LW, Levine M, Singhal AB. Dural Puncture Headache, Postpartum Angiopathy, Pre-Eclampsia and Cortical Vein Thrombosis After an Uncomplicated Pregnancy. Cephalalgia 2016; 27:461-4. [PMID: 17359517 DOI: 10.1111/j.1468-2982.2007.01285.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L W Katzin
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
Vitamin C (Ascorbic Acid), the antiscorbutic vitamin, cannot be synthesized by humans and other primates, and has to be obtained from diet. Ascorbic acid is an electron donor and acts as a cofactor for fifteen mammalian enzymes. Two sodium-dependent transporters are specific for ascorbic acid, and its oxidation product dehydroascorbic acid is transported by glucose transporters. Ascorbic acid is differentially accumulated by most tissues and body fluids. Plasma and tissue vitamin C concentrations are dependent on amount consumed, bioavailability, renal excretion, and utilization. To be biologically meaningful or to be clinically relevant, in vitro and in vivo studies of vitamin C actions have to take into account physiologic concentrations of the vitamin. In this paper, we review vitamin C physiology; the many phenomena involving vitamin C where new knowledge has accrued or where understanding remains limited; raise questions about the vitamin that remain to be answered; and explore lines of investigations that are likely to be fruitful.
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Affiliation(s)
- S J Padayatty
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - M Levine
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Habibollahi P, Gade T, Hunt S, Soulen M, Levine M, Nadolski G. ▪ FEATURED ABSTRACTNeoadjuvant transarterial chemoembolization (TACE) of cirrhotomimetic hepatocellular carcinoma: outcomes and comparison to non-cirrhotomimetic hepatocellular carcinoma. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.102] [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: 10/22/2022] Open
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Marshall AL, Levine M, Howell ML, Chang Y, Riklin E, Parry BA, Callahan RT, Okechukwu I, Ayres AM, Nahed BV, Goldstein JN. Dose-associated pulmonary complication rates after fresh frozen plasma administration for warfarin reversal. J Thromb Haemost 2016; 14:324-30. [PMID: 26644327 DOI: 10.1111/jth.13212] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 08/05/2015] [Accepted: 11/19/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED ESSENTIALS: Fresh frozen plasma (FFP) may be associated with a dose-based risk of pulmonary complications. Patients received FFP for warfarin reversal at a large academic hospital over a 3-year period. Almost 20% developed pulmonary complications, and the risk was highest after > 3 units of FFP. The risk of pulmonary complications remained significant in multivariable analysis. BACKGROUND Fresh frozen plasma (FFP) is often administered to reverse warfarin anticoagulation. Administration has been associated with pulmonary complications, but it is unclear whether this risk is dose-related. Aims We sought to characterize the incidence and dose relationship of pulmonary complications, including transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI), after FFP administration for warfarin reversal. METHODS We performed a structured retrospective review of patients who received FFP for warfarin reversal in the emergency department (ED) of an academic tertiary-care hospital over a 3-year period. Logistic regression was used to explore the relationship between FFP dose and risk of pulmonary events. RESULTS Two hundred and fifty-one patients met the inclusion criteria. Overall, 49 patients (20%) developed pulmonary complications, including 30 (12%) with TACO, two (1%) with TRALI, and 17 (7%) with pulmonary edema not meeting the criteria for TACO. Pulmonary complications were significantly more frequent in those who received > 3 units of FFP (34.0% versus 15.6%, 95% confidence interval for risk difference 7.9%-8.9%). After stratification by subtype of complication, only the risk of TACO was statistically significant (28.3% versus 7.6%, 95% confidence interval for risk difference 8.2%-16.6%). In multivariable analysis controlling for age, sex, initial systolic blood pressure, and intravenous fluids given in the ED, > 3 units of FFP remained a significant risk factor for pulmonary complications (odds ratio 2.49, 95% confidence interval 1.21-5.13). CONCLUSIONS Almost 20% of patients who received FFP for warfarin reversal developed pulmonary complications, primarily TACO, and this risk increased with > 3 units of FFP. Clinicians should be aware of and prepared to manage these complications.
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Affiliation(s)
| | - M Levine
- University of Southern California, Los Angeles, CA, USA
| | - M L Howell
- Massachusetts General Hospital, Boston, MA, USA
| | - Y Chang
- Massachusetts General Hospital, Boston, MA, USA
| | - E Riklin
- Massachusetts General Hospital, Boston, MA, USA
| | - B A Parry
- Massachusetts General Hospital, Boston, MA, USA
| | | | - I Okechukwu
- Massachusetts General Hospital, Boston, MA, USA
| | - A M Ayres
- Massachusetts General Hospital, Boston, MA, USA
| | - B V Nahed
- Massachusetts General Hospital, Boston, MA, USA
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Levine M, Marshall A, Howell M, Thomas S, Riklin E, Parry B, Callahan R, Okechukwu I, Dzik W, Goldstein J. 411 Thromboembolism After Emergency Warfarin Reversal With Fresh Frozen Plasma. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Levine M, Pizon A, Stellpflug S, Wiegand T, Villano J, Peak D, Thomas S. 387 Hypoglycemia in Acetaminophen-Induced Hepatic Failure: What Is the Significance? Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Suryaprasad A, Basavaraju SV, Hocevar SN, Theodoropoulos N, Zuckerman RA, Hayden T, Forbi JC, Pegues D, Levine M, Martin SI, Kuehnert MJ, Blumberg EA. Transmission of Hepatitis C Virus From Organ Donors Despite Nucleic Acid Test Screening. Am J Transplant 2015; 15:1827-35. [PMID: 25943299 DOI: 10.1111/ajt.13283] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [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: 11/10/2014] [Revised: 12/23/2014] [Accepted: 01/08/2015] [Indexed: 01/25/2023]
Abstract
Nucleic acid testing (NAT) for hepatitis C virus (HCV) is recommended for screening of organ donors, yet not all donor infections may be detected. We describe three US clusters of HCV transmission from donors at increased risk for HCV infection. Donor's and recipients' medical records were reviewed. Newly infected recipients were interviewed. Donor-derived HCV infection was considered when infection was newly detected after transplantation in recipients of organs from increased risk donors. Stored donor sera and tissue samples were tested for HCV RNA with high-sensitivity quantitative PCR. Posttransplant and pretransplant recipient sera were tested for HCV RNA. Quasispecies analysis of hypervariable region-1 was used to establish genetic relatedness of recipient HCV variants. Each donor had evidence of injection drug use preceding death. Of 12 recipients, 8 were HCV-infected-6 were newly diagnosed posttransplant. HCV RNA was retrospectively detected in stored samples from donor immunologic tissue collected at organ procurement. Phylogenetic analysis showed two clusters of closely related HCV variants from recipients. These investigations identified the first known HCV transmissions from increased risk organ donors with negative NAT screening, indicating very recent donor infection. Recipient informed consent and posttransplant screening for blood-borne pathogens are essential when considering increased risk donors.
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Affiliation(s)
- A Suryaprasad
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, GA
| | - S V Basavaraju
- Division of Healthcare Quality and Promotion, Office of Blood, Organ and Other Tissue Safety, Centers for Disease Control and Prevention, Atlanta, GA
| | - S N Hocevar
- Division of Healthcare Quality and Promotion, Office of Blood, Organ and Other Tissue Safety, Centers for Disease Control and Prevention, Atlanta, GA
| | - N Theodoropoulos
- Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University, Columbus, OH
| | - R A Zuckerman
- Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - T Hayden
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, GA
| | - J C Forbi
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, GA
| | - D Pegues
- Perelman School of Medicine at the University of Pennsylvania Health System, Philadelphia, PA
| | - M Levine
- Perelman School of Medicine at the University of Pennsylvania Health System, Philadelphia, PA
| | - S I Martin
- Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University, Columbus, OH
| | - M J Kuehnert
- Division of Healthcare Quality and Promotion, Office of Blood, Organ and Other Tissue Safety, Centers for Disease Control and Prevention, Atlanta, GA
| | - E A Blumberg
- Perelman School of Medicine at the University of Pennsylvania Health System, Philadelphia, PA
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Affiliation(s)
- M Levine
- Laboratory of Cell Biology and Genetics, National Institute of Diabetes, National Institutes of Health, Bethesda, Md
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Anderson J, Cameron EL, McAnany JJ, Levine M. Crowding and Visual Field Inhomogenieties. J Vis 2014. [DOI: 10.1167/14.10.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Tennant S, Simon R, Wang J, Pasetti M, Ernst R, Lees A, Galen J, Levine M. Bivalent vaccine strategies for invasive non-typhoidal Salmonella infections. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.426] [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: 12/01/2022] Open
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Levine M, Latmore M, Vandepitte C, Gadsden J, Hadzic A. It is 3 a.m. . . . do you know where your catheter tip is? Br J Anaesth 2014; 112:757-8. [DOI: 10.1093/bja/aeu069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Lee HS, Levine M, Guptill-Yoran C, Johnson AJ, von Kamecke P, Moore GE. Regional and temporal variations of Leptospira seropositivity in dogs in the United States, 2000-2010. J Vet Intern Med 2014; 28:779-88. [PMID: 24597659 PMCID: PMC4895461 DOI: 10.1111/jvim.12335] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 12/30/2013] [Accepted: 01/21/2014] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Previous studies have reported a seasonal increased risk for leptospirosis, but there is no consistent seasonality reported across regions in the United States. OBJECTIVES To evaluate and compare seasonal patterns in seropositivity for leptospirosis in dogs for 4 US regions (northeast [NE], midwest [MW], south-central [SC], and California-southern west coast [CS]). ANIMALS Forty four thousand nine hundred and sixteen canine serum samples submitted to a commercial laboratory for microscopic agglutination tests (MAT) from 2000 through 2010. METHODS In this retrospective study, positive cases were defined as MAT titers ≥1 : 3,200 for at least one of 7 tested serovars. Four geographic regions were defined, and MAT results were included in regional analyses based on hospital zipcode. A seasonal-trend decomposition method for times series was utilized for the analysis. Monthly variation in the seropositive rate was evaluated using a seasonal cycle subseries plot and logistic regression. RESULTS Two thousand and twelve of 44,916 (4.48%) samples were seropositive. Compared to seropositive rates for February, significantly higher monthly rates occurred during the 2nd half of the year in the MW (OR 3.92-6.35) and NE (OR 2.03-4.80) regions, and only in January (OR 2.34) and December (OR 1.74) in the SC region. Monthly seropositive rates indicative of seasonality were observed earlier in the calendar year for both CS and SC regions. CONCLUSIONS AND CLINICAL IMPORTANCE Seasonal patterns for seropositivity to leptospires differed by geographic region. Although risk of infection in dogs can occur year round, knowledge of seasonal trends can assist veterinarians in formulating differential diagnoses and evaluation of exposure risk.
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Affiliation(s)
- H S Lee
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN
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Harhay M, Lin E, Pai A, Harhay MO, Huverserian A, Mussell A, Abt P, Levine M, Bloom R, Shea J, Troxel A, Reese P. Early rehospitalization after kidney transplantation: assessing preventability and prognosis. Am J Transplant 2013; 13:3164-72. [PMID: 24165498 PMCID: PMC4108077 DOI: 10.1111/ajt.12513] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [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: 04/15/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 01/25/2023]
Abstract
Early rehospitalization after kidney transplantation (KT) is common and may predict future adverse outcomes. Previous studies using claims data have been limited in identifying preventable rehospitalizations. We assembled a cohort of 753 adults at our institution undergoing KT from January 1, 2003 to December 31, 2007. Two physicians independently reviewed medical records of 237 patients (32%) with early rehospitalization and identified (1) primary reason for and (2) preventability of rehospitalization. Mortality and graft failure were ascertained through linkage to the Scientific Registry of Transplant Recipients. Leading reasons for rehospitalization included surgical complications (15%), rejection (14%), volume shifts (11%) and systemic and surgical wound infections (11% and 2.5%). Reviewer agreement on primary reason (85% of cases) was strong (kappa = 0.78). Only 19 rehospitalizations (8%) met preventability criteria. Using logistic regression, weekend discharge (odds ratio [OR] 1.59, p = 0.01), waitlist time (OR 1.10, p = 0.04) and longer initial length of stay (OR 1.42, p = 0.03) were associated with early rehospitalization. Using Cox regression, early rehospitalization was associated with mortality (hazard ratio [HR] 1.55; p = 0.03) but not graft loss (HR 1.33; p = 0.09). Early rehospitalization has diverse causes and presents challenges as a quality metric after KT. These results should be validated prospectively at multiple centers to identify vulnerable patients and modifiable processes-of-care.
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Affiliation(s)
- M. Harhay
- Center for Clinical Epidemiology and Biostatistics, University of
Pennsylvania, Philadelphia, PA,Renal Division, Department of Medicine, University of Pennsylvania,
Philadelphia, PA
| | - E. Lin
- Department of Medicine, University of Pennsylvania, Philadelphia,
PA
| | - A. Pai
- Renal Division, Pennsylvania Hospital, Philadelphia, PA
| | - M. O. Harhay
- Center for Clinical Epidemiology and Biostatistics, University of
Pennsylvania, Philadelphia, PA
| | - A. Huverserian
- School of Medicine, Washington University, St. Louis, MO
| | - A. Mussell
- Center for Clinical Epidemiology and Biostatistics, University of
Pennsylvania, Philadelphia, PA
| | - P. Abt
- Department of Surgery, Transplant Institute, University of
Pennsylvania, Philadelphia, PA
| | - M. Levine
- Department of Surgery, Transplant Institute, University of
Pennsylvania, Philadelphia, PA
| | - R. Bloom
- Renal Division, Department of Medicine, University of Pennsylvania,
Philadelphia, PA
| | - J.A. Shea
- Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA
| | - A.B. Troxel
- Center for Clinical Epidemiology and Biostatistics, University of
Pennsylvania, Philadelphia, PA
| | - P.P. Reese
- Center for Clinical Epidemiology and Biostatistics, University of
Pennsylvania, Philadelphia, PA,Renal Division, Department of Medicine, University of Pennsylvania,
Philadelphia, PA,Department of Surgery, Transplant Institute, University of
Pennsylvania, Philadelphia, PA
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Segura A, Khorasanee J, McCarthy D, Chiampas G, Levine M, Malik S. Evaluation of a Revised Orthopedic Curriculum for Emergency Medicine Residents. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.06.033] [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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45
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Cameron L, Levine M, Anderson J. The effect of stimulus visibility on visual field inhomogeneities. J Vis 2013. [DOI: 10.1167/13.9.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Park S, Levine M, Dunne M. Neural representation of the navigability in a scene. J Vis 2013. [DOI: 10.1167/13.9.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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47
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Levine M, Froberg B, Ruha AM, Burns-Ewald M, Yen M, Claudius IA, Arthur AO, Tormoehlen L, Thomas SH. Assessing the toxicity and associated costs among pediatric patients admitted with unintentional poisonings of attention-deficit/hyperactivity disorder drugs in the United States. Clin Toxicol (Phila) 2013; 51:147-50. [PMID: 23473458 DOI: 10.3109/15563650.2013.772623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is widespread, with a national (United States) prevalence of nearly 10%. The 2011 changes in the diagnostic criteria will likely further increase the prevalence of this disorder. Little is known about the incidence of toxicity from unintentional poisonings of ADHD medications. This study attempted to determine the incidence of these ingestions and the corresponding financial impact in the United States. METHODS Four geographically different centers were chosen. Subjects with unintentional poisonings due to ADHD medications were included if the admission dates were between 2000 and 2002 (cohort A) or between 2009 and 2010 (cohort B). Using data from the participating hospitals and the number of monitored beds in each corresponding county, data were extrapolated on a national (United States) level. RESULTS Sixty-three subjects were admitted at four hospitals (18, cohort A and 45, cohort B). The crude incidence rate ratio increased in the later time frame as compared to that in the earlier time frame (incidence rate ratio, 3.13; 95% CI, 1.80-5.68; p < 0.0001). The median (IQR) charges per patient, adjusted for inflation, were $4780 ($3,895-$8,287) and $5912 ($3,432-$9,433) for cohorts A and B, respectively (p = 0.57). If the subjects in the participating counties were only admitted to the participating hospitals, the annual charges, extrapolated throughout the United States for the two periods, would be $2,419,016 and $8,129,538, respectively. If the subjects were evenly distributed across all pediatric monitored beds in a given county, the annual charges extrapolated throughout the United States for the two periods would be $5,694,232 and $24,126,640, respectively. CONCLUSION The incidence of unintentional poisonings from ADHD drugs is increasing and is associated with a significant cost.
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Affiliation(s)
- M Levine
- Department of Emergency Medicine, Section of Medical Toxicology, University of Southern California, Los Angeles, CA, USA.
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48
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Ackermann O, Levine M, Eckert K, Rülander C, Stanjek M, von Schulze Pellengahr C. [Uncertainty in the radiological evaluation of deformity in proximal humerus fractures]. Z Orthop Unfall 2013; 151:74-9. [PMID: 23423594 DOI: 10.1055/s-0032-1328194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The accurate measurement of the deformity of proximal humerus fractures is essential for a proper treatment, particularly in the growing bone. Due to the local pain the correct projection in standard X-rays is difficult to achieve and, in contrast to other joints, cannot be verified in the X-ray. Even with the correct projections a mismeasurement can occur when the rotation is 45° to both planes. The aim of this study was to objectify the error sources and reveal starting points for an improvement. MATERIAL AND METHODS In a three-step study we initially developed a mathemathical formula in cooperation with the faculty of mathematics of the University of Duisburg-Essen. This formula was proved with X-ray imaging of a steel rod which was bent 120°, simulating a 60° deformity. X-ray images with different rotation and tilt were taken and compared with the values calculated with the above-mentioned formula. In the third step X-rays of a healthy shoulder in different rotation and tilt positions were presented to 2 orthopaedic and 3 radiological consultants. The aim was to determine the direction and amount of rotation and tilt. RESULTS The first theoretical step resulted in a mathematical formula which describes the optical deformation based on real deformation, tilt and rotation. The evaluation showed a mean difference of 0.5° (0-1.2°) between the calculated and the measured values. In the third step, evaluation of the X-rays of a shoulder showed that two in 50 (4 %) of the values were correct, in additional 28 cases (56 %) the tendency of the direction of the rotation was correct, the extent of the rotation was missed by 19.6° (0-60°). Ante- and retroversion were evaluated correctly in nine cases (18 %), the extent was missed by a mean of 23° (0-50°). In seven cases (18 %) the tendency for rotation and ante-/retroversion was correct, in 11 cases (22 %) one or both aspects could not be evaluated, in additional 8 cases (16 %) the extent could not be estimated. DISCUSSION Our results show that rotation and tilt of the proximal humerus cannot be estimated in shoulder X-rays and therefore a reliable measurement of the deformity of proximal humerus fractures is extremely unsafe. This problem is relevant for clinical practice because of the high likeliness of unaccurate projections in shoulder X-ray imaging after trauma. Especially for the growing bone the problem is evident, so that new ways of determining the deformity are mandatory.
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Affiliation(s)
- O Ackermann
- Orthopädie und Unfallchirurgie, Sana-Klinikum Duisburg, Klinik der Sana-Gruppe.
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Welsh JL, Wagner BA, van't Erve TJ, Zehr PS, Berg DJ, Halfdanarson TR, Yee NS, Bodeker KL, Du J, Roberts LJ, Drisko J, Levine M, Buettner GR, Cullen JJ. Pharmacological ascorbate with gemcitabine for the control of metastatic and node-positive pancreatic cancer (PACMAN): results from a phase I clinical trial. Cancer Chemother Pharmacol 2013; 71:765-75. [PMID: 23381814 DOI: 10.1007/s00280-013-2070-8] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 12/31/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment for pancreatic cancer with pharmacological ascorbate (ascorbic acid, vitamin C) decreases tumor progression in preclinical models. A phase I clinical trial was performed to establish safety and tolerability of pharmacological ascorbate combined with gemcitabine in patients with biopsy-proven stage IV pancreatic adenocarcinoma. DESIGN Nine subjects received twice-weekly intravenous ascorbate (15-125 g) employing Simon's accelerated titration design to achieve a targeted post-infusion plasma level of ≥350 mg/dL (≥20 mM). Subjects received concurrent gemcitabine. Disease burden, weight, performance status, hematologic and metabolic laboratories, time to progression and overall survival were monitored. RESULTS Mean plasma ascorbate trough levels were significantly higher than baseline (1.46 ± 0.02 vs. 0.78 ± 0.09 mg/dL, i.e., 83 vs. 44 μM, p < 0.001). Adverse events attributable to the drug combination were rare and included diarrhea (n = 4) and dry mouth (n = 6). Dose-limiting criteria were not met for this study. Mean survival of subjects completing at least two cycles (8 weeks) of therapy was 13 ± 2 months. CONCLUSIONS Data suggest pharmacologic ascorbate administered concurrently with gemcitabine is well tolerated. Initial data from this small sampling suggest some efficacy. Further studies powered to determine efficacy should be conducted.
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Affiliation(s)
- J L Welsh
- Department of Surgery, 1528 JCP-UIHC, The University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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50
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Ruebner R, Goldberg D, Abt PL, Bahirwani R, Levine M, Sawinski D, Bloom RD, Reese PP. Risk of end-stage renal disease among liver transplant recipients with pretransplant renal dysfunction. Am J Transplant 2012; 12:2958-65. [PMID: 22759237 PMCID: PMC3527009 DOI: 10.1111/j.1600-6143.2012.04177.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [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: 02/06/2023]
Abstract
Guidelines recommend restricting simultaneous liver-kidney (SLK) transplant to candidates with prolonged dialysis or estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m(2) for 90 days. However, few studies exist to support the latter recommendation. Using Scientific Registry of Transplant Recipients and Medicare dialysis data, we assembled a cohort of 4997 liver transplant recipients from February 27, 2002-January 1, 2008. Serial eGFRs were calculated from serum creatinines submitted with MELD reports. We categorized recipients by eGFR patterns in the 90 days pretransplant: Group 1 (eGFR always >30), Group 2 (eGFR fluctuated), Group 3 (eGFR always <30) and Group 4 (short-term dialysis). For Group 2, we characterized fluctuations in renal function using time-weighted mean eGFR. Among liver-alone recipients in Group 3, the rate of end-stage renal disease (ESRD) by 3 years was 31%, versus <10% for other groups (p < 0.001). In multivariable Cox regression, eGFR Group, diabetes (HR 2.65, p < 0.001) and black race (HR 1.83, p = 0.02) were associated with ESRD. Among liver-alone recipients in Group 2, only diabetics with time-weighted mean eGFR <30 had a substantial ESRD risk (25.6%). In summary, among liver transplant candidates not on prolonged dialysis, SLK should be considered for those whose eGFR is always <30 and diabetic candidates whose weighted mean eGFR is <30 for 90 days.
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Affiliation(s)
- R Ruebner
- Children’s Hospital of Philadelphia, Renal Division,University of Pennsylvania, Center for Clinical Epidemiology and Biostatistics
| | - D Goldberg
- University of Pennsylvania, Center for Clinical Epidemiology and Biostatistics,University of Pennsylvania, Gastroenterology Division, Department of Medicine
| | - PL Abt
- University of Pennsylvania, Transplant Institute, Department of Surgery
| | - R Bahirwani
- University of Pennsylvania, Gastroenterology Division, Department of Medicine
| | - M Levine
- University of Pennsylvania, Transplant Institute, Department of Surgery
| | - D Sawinski
- University of Pennsylvania, Renal Division, Department of Medicine
| | - RD Bloom
- University of Pennsylvania, Renal Division, Department of Medicine
| | - PP Reese
- University of Pennsylvania, Center for Clinical Epidemiology and Biostatistics,University of Pennsylvania, Transplant Institute, Department of Surgery,University of Pennsylvania, Renal Division, Department of Medicine
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