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J. Jakobson D, Cohen O, Cherniavsky E, Batumsky M, Fuchs L, Yellin A. Ultrasonography can replace chest X-rays in the postoperative care of thoracic surgical patients. PLoS One 2022; 17:e0276502. [PMID: 36264957 PMCID: PMC9584362 DOI: 10.1371/journal.pone.0276502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives Lung ultrasound accurately identifies pulmonary and pleural pathologies. Presently it has not been accepted as a routine examination in the postoperative follow-up of thoracic surgical patients. The present study aimed to compare thoracic ultrasonography with chest X-ray for detecting and clinical relevance of pneumothorax, pleural effusion, and lung consolidation and determine whether ultrasonography could replace chest X-ray as the standard examination after surgery. Methods In this blinded, prospective, single-center study, lung ultrasound images were obtained within 2 hours of post-operative routine chest X-ray. A severity score was given to each examination in each technique. Lung ultrasound and chest X-ray results were compared by three methods: absolute comparison of normal to abnormal, the degree of pathology, and the clinical findings’ relevance. Results Eighty patients were enrolled from 2013 to 2017, and 215 ultrasonography images were obtained. For pneumothorax, the precise overlap was found in 129/180 (72%) images. In 24% of examinations, X-ray missed ultrasonography findings. There was an agreement between studies in 80/212 (38%) images for pleural effusion. 60% of pleural effusions were missed by chest X-ray and detected by ultrasonography, and only 2.4% were missed by ultrasound, all very small. Clinically relevant fluid accumulation found a precise match in 80%, and 20% were found only by lung ultrasound. For lung consolidation, a 100% overlap was found with both methods. Conclusions Our results suggest that lung ultrasound may replace chest X-ray as the standard examination in the postoperative care of patients undergoing thoracic surgical procedures.
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Affiliation(s)
- Daniel J. Jakobson
- Intensive Care Department, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Ornit Cohen
- Faculty of Public Health Ben-Gurion University, Beer-Sheba, Israel
| | - Evgenia Cherniavsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Radiology Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Moris Batumsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- General Surgery Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Lior Fuchs
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Intensive Care Department, Soroka University Medical Center, Beer Sheba, Israel
- * E-mail:
| | - Alon Yellin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Thoracic Surgery Department, Barzilai University Medical Center, Ashkelon, Israel
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Jendle J, Buompensiere MI, Holm AL, de Portu S, Malkin SJP, Cohen O. A Response to: Letter to the Editor with Regard to the Cost-Effectiveness of an Advanced Hybrid Closed-Loop System in People with Type 1 Diabetes: A Health Economic Analysis in Sweden. Diabetes Ther 2022; 13:1125-1129. [PMID: 35403952 PMCID: PMC9076762 DOI: 10.1007/s13300-022-01252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- J Jendle
- Institute of Medical Sciences, Örebro University, Campus USÖ, 701 82, Örebro, Sweden.
| | | | - A L Holm
- Medtronic Denmark, Copenhagen, Denmark
| | - S de Portu
- Medtronic International Trading Sàrl, Tolechenaz, Switzerland
| | - S J P Malkin
- Ossian Health Economics and Communications, Basel, Switzerland
| | - O Cohen
- Medtronic International Trading Sàrl, Tolechenaz, Switzerland
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Jendle J, Buompensiere MI, Holm AL, de Portu S, Malkin SJP, Cohen O. The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System in People with Type 1 Diabetes: a Health Economic Analysis in Sweden. Diabetes Ther 2021; 12:2977-2991. [PMID: 34596879 PMCID: PMC8519965 DOI: 10.1007/s13300-021-01157-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/15/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Swedish National Diabetes Registry data show a correlation of improved glycemic control in people with type 1 diabetes (T1D) with increased use of diabetes technologies over the past 25 years. However, novel technologies are often associated with a high initial outlay. The aim of the present study was to evaluate the long-term cost-effectiveness of the advanced hybrid closed-loop (AHCL) MiniMed 780G system versus intermittently scanned continuous glucose monitoring (isCGM) plus self-injection of multiple daily insulin (MDI) or continuous subcutaneous insulin infusion (CSII) in people with T1D in Sweden. METHODS Outcomes were projected over patients' lifetimes using the IQVIA CORE Diabetes Model (v9.0). Clinical data, including changes in glycated hemoglobin (HbA1c) and hypoglycemia rates, were sourced from observational studies and a randomized crossover trial. Modeled patients were assumed to receive the treatments for their lifetimes, with HbA1c kept constant following the application of treatment effects. Costs were accounted from a societal perspective and expressed in Swedish krona (SEK). Utilities and days off work estimates were taken from published sources. RESULTS The MiniMed 780G system was associated with an improvement in life expectancy of 0.16 years and an improvement in quality-adjusted life expectancy of 1.95 quality-adjusted life years (QALYs) versus isCGM plus MDI or CSII. These clinical benefits were due to a reduced incidence and a delayed time to onset of diabetes-related complications. Combined costs were estimated to be SEK 727,408 (EUR 72,741) higher with MiniMed 780G, with treatment costs partially offset by direct cost savings from the avoidance of diabetes-related complications and indirect cost savings from the avoidance of lost workplace productivity. The MiniMed 780G system was associated with an incremental cost-effectiveness ratio of SEK 373,700 per QALY gained. CONCLUSIONS Based on a willingness-to-pay threshold of SEK 500,000 per QALY gained, the MiniMed 780G system was projected to be cost-effective versus isCGM plus MDI or CSII for the treatment of T1D in Sweden.
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Affiliation(s)
- Johan Jendle
- Institute of Medical Sciences, Campus USÖ, Örebro University, 701 82, Örebro, Sweden.
| | | | - A L Holm
- Medtronic Denmark, Copenhagen, Denmark
| | - S de Portu
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - S J P Malkin
- Ossian Health Economics and Communications, Basel, Switzerland
| | - O Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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Nachman D, Eisenkraft A, Maor Y, Constantini K, Goldstein G, Levy R, Halberthal M, Horowitz NA, Golan R, Rosenberg E, Lavon E, Cohen O, Shapira G, Shomron N, Gepner Y. Continuous monitoring of advanced hemodynamic parameters shows early cardiovascular changes in a cohort of 492 COVID-19 hospitalized patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3090] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
COVID-19 exerts deleterious cardiopulmonary effects, leading to worse prognosis in the most effected.
Purpose
The aim of this retrospective multi-center observational cohort study was to analyze the trajectories of key advanced hemodynamic parameters amongst hospitalized COVID-19 patients according to different risk populations using a chest-patch wearable providing continuous remote patient monitoring.
Methods
The study was conducted in five COVID-19 isolation units. Patients admitted to the units were connected to a photoplethysmography based noninvasive remote advanced hemodynamic monitor after completing a basic risk factor survey. Physiological parameters were measured every 15 minutes during the hospitalization, including cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), heart rate, blood pressure (BP), respiratory rate, blood oxygen saturation (SpO2), and body temperature.
Results
492 COVID-19 patients (179 females, average age 58.7 years) were included in the final analysis, with more than 3 million measurements collected during an average of 75.3 hours. Overall, within the first five days of hospitalizations we found a significant increase in SVR, and a significant decrease in SpO2, DBP, CO and CI (p<0.01 for all). The changes were more prominent in high risk populations- males, older age and obesity and had a temporal correspondence to changes in respiratory parameters.
Conclusions
This is the first comprehensive continuous advanced hemodynamic profiling of COVID-19 patients. Worse hemodynamic status was prominent in high risk populations.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Nachman
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - A Eisenkraft
- The Hebrew University Faculty of Medicine, Jerusalem, Israel, and the Israel Defense Force Medical, Institute for Research in Military Medicine, Jerusalem, Israel
| | - Y Maor
- The Edith Wolfson Medical Center, Holon, Israel
| | - K Constantini
- Tel Aviv University, Department of Epidemiology, Preventive Medicine, School of Public Health, Sylvan Adams Sports center, Tel Aviv, Israel
| | - G Goldstein
- Tel Aviv University, Department of Epidemiology, Preventive Medicine, School of Public Health, Sylvan Adams Sports center, Tel Aviv, Israel
| | - R Levy
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | | | | - R Golan
- Baruch Padeh Medical Center, The Faculty of Medicine in Galilee, Bar Ilan University, Tiberias, Israel
| | - E Rosenberg
- Soroka University Medical Center, Beer Sheva, Israel
| | - E Lavon
- Kaplan Medical Center, Rehovot, Israel
| | - O Cohen
- The Edith Wolfson Medical Center, Holon, Israel
| | - G Shapira
- Tel Aviv University, Tel Aviv, Israel
| | - N Shomron
- Tel Aviv University, Tel Aviv, Israel
| | - Y Gepner
- Tel Aviv University, Department of Epidemiology, Preventive Medicine, School of Public Health, Sylvan Adams Sports center, Tel Aviv, Israel
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Eisenkraft A, Maor Y, Constantini K, Goldstein N, Nachman D, Levy R, Halberthal M, Horowitz NA, Golan R, Rosenberg E, Lavon E, Cohen O, Shapira G, Shomron N, Ishay AB, Sand E, Merin R, Fons M, Littman R, Gepner Y. Continuous Remote Patient Monitoring Shows Early Cardiovascular Changes in COVID-19 Patients. J Clin Med 2021; 10:4218. [PMID: 34575328 PMCID: PMC8468944 DOI: 10.3390/jcm10184218] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 exerts deleterious cardiopulmonary effects, leading to a worse prognosis in the most affected. This retrospective multi-center observational cohort study aimed to analyze the trajectories of key vitals amongst hospitalized COVID-19 patients using a chest-patch wearable providing continuous remote patient monitoring of numerous vital signs. The study was conducted in five COVID-19 isolation units. A total of 492 COVID-19 patients were included in the final analysis. Physiological parameters were measured every 15 min. More than 3 million measurements were collected including heart rate, systolic and diastolic blood pressure, cardiac output, cardiac index, systemic vascular resistance, respiratory rate, blood oxygen saturation, and body temperature. Cardiovascular deterioration appeared early after admission and in parallel with changes in the respiratory parameters, showing a significant difference in trajectories within sub-populations at high risk. Early detection of cardiovascular deterioration of COVID-19 patients is achievable when using frequent remote patient monitoring.
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Affiliation(s)
- Arik Eisenkraft
- Institute for Research in Military Medicine, The Hebrew University Faculty of Medicine, P.O. Box 12272, Jerusalem 9112102, Israel;
- The Israel Defense Force Medical Corps, P.O. Box 12272, Jerusalem 9112102, Israel
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Yasmin Maor
- Wolfson Medical Center, 62 Ha-Lokhamim St. 62, Holon 58100, Israel; (Y.M.); (O.C.)
- The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.S.); (N.S.)
| | - Keren Constantini
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (K.C.); (N.G.); (Y.G.)
| | - Nir Goldstein
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (K.C.); (N.G.); (Y.G.)
| | - Dean Nachman
- Institute for Research in Military Medicine, The Hebrew University Faculty of Medicine, P.O. Box 12272, Jerusalem 9112102, Israel;
- The Israel Defense Force Medical Corps, P.O. Box 12272, Jerusalem 9112102, Israel
- Heart Institute, Hadassah Ein Kerem Medical Center, P.O. Box 911201, Jerusalem 9112102, Israel
| | - Ran Levy
- Maccabi Healthcare Services, P.O. Box 50493, Tel Aviv 68125, Israel;
| | - Michael Halberthal
- General Directorate Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel; (M.H.); (N.A.H.)
- The Bruce Rappaport Faculty of Medicine, Technion, P.O. Box 9649, Haifa 3525433, Israel
| | - Netanel A. Horowitz
- General Directorate Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel; (M.H.); (N.A.H.)
- The Bruce Rappaport Faculty of Medicine, Technion, P.O. Box 9649, Haifa 3525433, Israel
| | - Ron Golan
- The Baruch Padeh Medical Center Poriya, The Faculty of Medicine in Galilee, Bar Ilan University, Upper Galilee, Poria 1528001, Israel;
| | - Elli Rosenberg
- Internal Medicine A, The Soroka University Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Be’er Sheva 84101, Israel;
| | - Eitan Lavon
- The Kaplan Medical Center, The Hebrew University Faculty of Medicine, P.O. Box 1, Rehovot 76100, Israel;
| | - Ornit Cohen
- Wolfson Medical Center, 62 Ha-Lokhamim St. 62, Holon 58100, Israel; (Y.M.); (O.C.)
- The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.S.); (N.S.)
- Faculty of Health Science, Ben-Gurion University of the Negev, P.O. Box 653, Be’er Sheva 8410501, Israel
| | - Guy Shapira
- The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.S.); (N.S.)
| | - Noam Shomron
- The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.S.); (N.S.)
| | - Arik Ben Ishay
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Efrat Sand
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Roei Merin
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Meir Fons
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Romi Littman
- Biobeat Technologies Ltd., 22 Efal St., Petah Tikva 4951122, Israel; (A.B.I.); (E.S.); (R.M.); (M.F.); (R.L.)
| | - Yftach Gepner
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; (K.C.); (N.G.); (Y.G.)
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Lakstein D, Daglan E, Livshits G, Cohen O. [CAN HIP FRACTURE PATTERN OR TYPE OF SURGERY PREDICT ONE-YEAR MORTALITY OR MOBILITY?]. Harefuah 2020; 159:797-803. [PMID: 33210849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Several demographic and medical factors have an established effect on mortality and function after hip fractures, however varying fracture characteristics and surgical factors have been less thoroughly investigated. The study assessed the impact of specific fracture patterns on mortality and mobility one year post hip fracture. Other surgical factors including the type of intervention, major complications and sequential fractures were assessed as well. METHODS An institutional hip fracture registry was reviewed. Mobility status scores were calculated one year post-operatively. RESULTS Thirty days mortality was 4.6% and one year mortality was 19.9%. There was no significant effect of fracture type on mortality. However, patients receiving hemiarthroplasty had a significantly higher mortality (28.1%) than other patients receiving internal fixation (18.6%) or total hip arthroplasty (4%). An increased mobility status after intra-capsular fractures over extracapsular fractures was demonstrated. Patients receiving total hip arthroplasty had significantly better mobility at one year than patients with fracture fixation or hemiarthroplasty. Major complications and sequential fractures had no significant effect on outcome. CONCLUSIONS Critical factors that influence decision making for orthopedic surgeons are revealed to have a lesser effect on the patient's ultimate outcome.
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Affiliation(s)
- Dror Lakstein
- Orthopedic Department, E. Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Efrat Daglan
- Orthopedic Department, E. Wolfson Medical Center, Holon, Israel
| | - Gilad Livshits
- Orthopedic Department, E. Wolfson Medical Center, Holon, Israel
| | - Ornit Cohen
- Orthopedic Department, Barzilai Medical Center, Ashkelon, Israel
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Cohen O, Ismail A, Manwani R, Ravichandran S, Foard D, Mahmood S, Sachchithanantham S, Martinez-Naharro A, Fontana M, Lachmann H, Hawkins P, Gillmore J, Whelan C, Wechalekar A. Global longitudinal strain predicts survival and response in patients with systemic AL amyloidosis. analysis of 915 patients from the ALchemy prospective trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac involvement determines prognosis in systemic AL amyloidosis. The extent is assessed by biomarker-based staging systems. This a prospective report of a large cohort of patients assessing the utility of changes in longitudinal function by 2D strain (GLS%), impairment - a hallmark of amyloidosis.
Purpose
To evaluate the prognostic role of GLS% and other echocardiographic parameters in systemic AL amyloidosis.
Methods
915 newly diagnosed patients seen at the UK National Amyloidosis Centre (February 2010–August 2017) were included. All patients underwent 6-monthly comprehensive assessments inclusive of echocardiogram. The European modification of the Mayo 2004 staging was used with Mayo stage III patients stratified into IIIa (NT-proBNP <8500ng/L) and IIIb (NT-proBNP ≥8500ng/L).
Results
653/915 (71.4%) patients had cardiac involvement. Mayo stage 1, 2, 3a and 3b in 144 (15.7%), 302 (33.0%) 344 (37.6%) and 125 (13.7%) respectively. The median NT-proBNP was 2228ng/L and TNT was 0.54ng/ml. The GLS% significantly worsened with increasing Mayo stage (p<0.0001 between GLS% for each Mayo stage). Poorer baseline GLS% associated with significantly worse OS and stratified patients into three groups: GLS% <−12.8%: OS 69.1 months; GLS% −12.8% to −9%: OS 54.5 months; GLS% >−9%: OS 45.3 months (p<0.0001). On univariate analysis, 11/14 parameters predicted survival (LV wall thickness, LV ejection fraction, systolic velocities of the septal (s'sep) and lateral mitral annulus (s' lat), mitral annulus movement at the lateral corner (e' lat), transmitral early peak flow velocity (E) divided by tissue Doppler mitral annular motion velocity (e') – E/e' and mitral annular plane systolic excursion (MAPSE)). Baseline GLS% >−17% was independent of Mayo stage in predicting survival [Mayo II: Hazard ratio (HR) 2.10 (95% CI: 1.12–3.92) p=0.02, Mayo III: HR 3.94 (95% CI: 2.13–7.32) p<0.0001, Mayo IV: HR 7.49 (95% CI: 3.94–14.21) p<0.0001, GLS <17%: HR 2.14 (95% CI: 1.59–2.88) p<0.0001]. At 12 months, only patients in a haematological complete response (CR) had significant improvement in overall GLS% (p=0.02) as well as baso-lateral (p=0.0004) and baso-septal (p=0.0001) GLS% and MAPSE (p=0.002). The OS was significantly better in patients who achieved a minimum absolute improvement in GLS% of 1.5% improvement (not reached in those with improved GLS% vs. 72 mo in those without) (p=0.034)).
Conclusion
These data show that baseline GLS% is an independent predictor of survival in AL amyloidosis. GLS% is the first functional marker that is independent of the Mayo staging in predicting outcomes and should be incorporated in prognostic staging for patients with AL amyloidosis. GLS% shows improvement in patients who achieve a complete haematologic response to treatment and improvement in GLS% of 1.5% is associated with improved outcomes. An absolute improvement in GLS% should be considered as a criterion for cardiac response in AL amyloidosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Cohen
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - A Ismail
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - R Manwani
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - S Ravichandran
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - D Foard
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - S Mahmood
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - S Sachchithanantham
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - A Martinez-Naharro
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - M Fontana
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - H Lachmann
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - P Hawkins
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - J Gillmore
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - C Whelan
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - A.D Wechalekar
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
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Cohen O, Boumaza X, Alvarez M, Porte L, Lansalot P, Martin-Blondel G, Delobel P. Épidémie d’oreillons en milieu sportif chez des patients correctement vaccinés. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.393] [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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Cohen O, Gabay S, Khafif A. Insertion of a vacuum based drain for post-parotidectomy non-resolving seroma in an outpatient setting. Br J Oral Maxillofac Surg 2020; 59:197-201. [PMID: 33349493 DOI: 10.1016/j.bjoms.2020.08.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/06/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
We describe a novel technique for the insertion of a vacuum drain, in an outpatient setting, for persistent seroma post-parotidectomy. This is a retrospective case series of a single academic centre. The complete medical records of all patients who underwent parotidectomy between 2014 and 2019 were reviewed. Data regarding demographics, comorbidities, and intraoperative and postoperative courses were extracted for patients for whom a vacuum drain was inserted due to persistent seroma. A size 8 Fr drain was inserted using a novel approach through the parotidectomy incision using 'Biovac' (Biometrix) 50ml, Trocar kit, that had been adjusted and modified for this purpose. Two hundred and eighteen patients had had parotidectomy during the study period. Eight patients (3.6%) underwent insertion of the drain due to persistent seroma. In three patients (37.5%) no drain was inserted during the initial surgery. The mean (SD) time between surgery and insertion of the outpatient vacuum drain was 10 (5) days. All drain insertions were uneventful and no complications were noted. The mean (SD) time for outpatient vacuum drain removal was 12.75 (4.3) days. A single patient (12.5%) underwent additional needle aspiration of 5cc few days following removal of the drain. Persistent seromas may be managed in an outpatient clinic with good results and a high safety profile.
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Affiliation(s)
- O Cohen
- A.R.M. Center for Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel.
| | - S Gabay
- A.R.M. Center for Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - A Khafif
- A.R.M. Center for Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
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Waks AG, Cohen O, Kochupurakkal B, Kim D, Dunn CE, Buendia Buendia J, Wander S, Helvie K, Lloyd MR, Marini L, Hughes ME, Freeman SS, Ivy SP, Geradts J, Isakoff S, LoRusso P, Adalsteinsson VA, Tolaney SM, Matulonis U, Krop IE, D'Andrea AD, Winer EP, Lin NU, Shapiro GI, Wagle N. Reversion and non-reversion mechanisms of resistance to PARP inhibitor or platinum chemotherapy in BRCA1/2-mutant metastatic breast cancer. Ann Oncol 2020; 31:590-598. [PMID: 32245699 DOI: 10.1016/j.annonc.2020.02.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/05/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Little is known about mechanisms of resistance to poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPi) and platinum chemotherapy in patients with metastatic breast cancer and BRCA1/2 mutations. Further investigation of resistance in clinical cohorts may point to strategies to prevent or overcome treatment failure. PATIENTS AND METHODS We obtained tumor biopsies from metastatic breast cancer patients with BRCA1/2 deficiency before and after acquired resistance to PARPi or platinum chemotherapy. Whole exome sequencing was carried out on each tumor, germline DNA, and circulating tumor DNA. Tumors underwent RNA sequencing, and immunohistochemical staining for RAD51 foci on tumor sections was carried out for functional assessment of intact homologous recombination (HR). RESULTS Pre- and post-resistance tumor samples were sequenced from eight patients (four with BRCA1 and four with BRCA2 mutation; four treated with PARPi and four with platinum). Following disease progression on DNA-damaging therapy, four patients (50%) acquired at least one somatic reversion alteration likely to result in functional BRCA1/2 protein detected by tumor or circulating tumor DNA sequencing. Two patients with germline BRCA1 deficiency acquired genomic alterations anticipated to restore HR through increased DNA end resection: loss of TP53BP1 in one patient and amplification of MRE11A in another. RAD51 foci were acquired post-resistance in all patients with genomic reversion, consistent with reconstitution of HR. All patients whose tumors demonstrated RAD51 foci post-resistance were intrinsically resistant to subsequent lines of DNA-damaging therapy. CONCLUSIONS Genomic reversion in BRCA1/2 was the most commonly observed mechanism of resistance, occurring in four of eight patients. Novel sequence alterations leading to increased DNA end resection were seen in two patients, and may be targetable for therapeutic benefit. The presence of RAD51 foci by immunohistochemistry was consistent with BRCA1/2 protein functional status from genomic data and predicted response to later DNA-damaging therapy, supporting RAD51 focus formation as a clinically useful biomarker.
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Affiliation(s)
- A G Waks
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Broad Institute of MIT and Harvard, Cambridge, USA; Harvard Medical School, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - O Cohen
- Broad Institute of MIT and Harvard, Cambridge, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - B Kochupurakkal
- Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA
| | - D Kim
- Broad Institute of MIT and Harvard, Cambridge, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - C E Dunn
- Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA
| | - J Buendia Buendia
- Broad Institute of MIT and Harvard, Cambridge, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - S Wander
- Broad Institute of MIT and Harvard, Cambridge, USA; Harvard Medical School, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA; Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA
| | - K Helvie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - M R Lloyd
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; University of Massachusetts Medical School, Worcester, USA
| | - L Marini
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - M E Hughes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - S S Freeman
- Broad Institute of MIT and Harvard, Cambridge, USA
| | - S P Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, USA
| | - J Geradts
- City of Hope Comprehensive Cancer Center, Duarte, USA
| | - S Isakoff
- Harvard Medical School, Boston, USA; Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, USA
| | | | | | - S M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - U Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - I E Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - A D D'Andrea
- Harvard Medical School, Boston, USA; Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - E P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - N U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - G I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA; Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA
| | - N Wagle
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Broad Institute of MIT and Harvard, Cambridge, USA; Harvard Medical School, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA.
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Barroso-Sousa R, Jain E, Cohen O, Kim D, Buendia-Buendia J, Winer E, Lin N, Tolaney SM, Wagle N. Prevalence and mutational determinants of high tumor mutation burden in breast cancer. Ann Oncol 2020; 31:387-394. [PMID: 32067680 DOI: 10.1016/j.annonc.2019.11.010] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [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: 05/21/2019] [Revised: 11/14/2019] [Accepted: 11/17/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND High tumor mutation burden (TMB) can benefit immunotherapy for multiple tumor types, but the prevalence of hypermutated breast cancer is not well described. The aim of this study was to evaluate the frequency, mutational patterns, and genomic profile of hypermutated breast cancer. PATIENTS AND METHODS We used de-identified data from individuals with primary or metastatic breast cancer from six different publicly available genomic studies. The prevalence of hypermutated breast cancer was determined among 3969 patients' samples that underwent whole exome sequencing or gene panel sequencing. The samples were classified as having high TMB if they had ≥10 mutations per megabase (mut/Mb). An additional eight patients were identified from a Dana-Farber Cancer Institute cohort for inclusion in the hypermutated cohort. Among the patients with high TMB, the mutational patterns and genomic profiles were determined. A subset of patients was treated with regimens containing PD-1 inhibitors. RESULTS The median TMB was 2.63 mut/Mb. The median TMB significantly varied according to the tumor subtype (HR-/HER2- >HER2+ >HR+/HER2-, P < 0.05) and sample type (metastatic > primary, P = 2.2 × 10-16). Hypermutated tumors were found in 198 patients (5%), with enrichment in metastatic versus primary tumors (8.4% versus 2.9%, P = 6.5 × 10-14). APOBEC activity (59.2%), followed by mismatch repair deficiency (MMRd; 36.4%), were the most common mutational processes among hypermutated tumors. Three patients with hypermutated breast cancer-including two with a dominant APOBEC activity signature and one with a dominant MMRd signature-treated with pembrolizumab-based therapies derived an objective and durable response to therapy. CONCLUSION Hypermutation occurs in 5% of all breast cancers with enrichment in metastatic tumors. Different mutational signatures are present in this population with APOBEC activity being the most common dominant process. Preliminary data suggest that hypermutated breast cancers are more likely to benefit from PD-1 inhibitors.
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Affiliation(s)
- R Barroso-Sousa
- Department of Medical Oncology; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - E Jain
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA; Broad Institute of MIT and Harvard, Cambridge, USA
| | - O Cohen
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA; Broad Institute of MIT and Harvard, Cambridge, USA
| | - D Kim
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA; Broad Institute of MIT and Harvard, Cambridge, USA
| | - J Buendia-Buendia
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA; Broad Institute of MIT and Harvard, Cambridge, USA
| | - E Winer
- Department of Medical Oncology; Harvard Medical School, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA
| | - N Lin
- Department of Medical Oncology; Harvard Medical School, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA
| | - S M Tolaney
- Department of Medical Oncology; Harvard Medical School, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA
| | - N Wagle
- Department of Medical Oncology; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA; Broad Institute of MIT and Harvard, Cambridge, USA; Harvard Medical School, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA.
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Hershkovitz F, Cohen O, Zilberman U. Microhardness of three glass-ionomer cements during setting and up to 15 days in vitro, and after 5 to 10 years in vivo. Quintessence Int 2020; 51:440-446. [PMID: 32253393 DOI: 10.3290/j.qi.a44372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To compare the microhardness and ion content of three glass-ionomer cements (GICs) during setting and up to 15 days, to composite resin-based material in vitro, and after 5 to 10 years in vivo. METHOD AND MATERIALS Disks of three GICs, EQUIA Fil, Riva Self Cure, and Ketac Molar were examined in vitro for microhardness using Vickers indentations after 15 to 60 minutes, 24 hours, and 8 and 15 days, and compared to composite material, Spectrum. The ion content of the GIC and composite was analyzed using the energy dispersive spectroscopy program of a scanning electron microscope. A primary second molar restored with GIC normally exfoliated after 5 years, and a third molar restored with GIC extracted due to periodontitis after 10 years, were sliced through the restoration buccolingually, and the microhardness of the restoration and of the dentin was measured. RESULTS In comparison to composite material, the Vickers value for the GICs were similar or better after 24 hours to 15 days. The amount of fluorine was three times higher in EQUIA Fil and Riva Self Cure in comparison with Ketac Molar, after 20 days. After 5 years in vivo, the microhardness of GICs was similar to dentin and after 10 years it was significantly higher than that of the dentin. CONCLUSION The microhardness of GICs was comparable to composite material after only 24 hours. In vivo the microhardness of GICs increased and after 10 years in vivo it was higher than that of the dentin. After 20 days the amount of fluorine was still high in Riva Self Cure and EQUIA Fil.
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Cohen O, Adi M, Shapira-Galitz Y, Halperin D, Warman M. Anatomic variations of the paranasal sinuses in the general pediatric population. Rhinology 2019; 57:206-212. [PMID: 30778427 DOI: 10.4193/rhin18.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence of sinuses' anatomic variations in the healthy pediatric population has not been studied. The study describes the prevalence of known anatomic variations with regard to gender and age in this population. METHODS A single academic institute observational cohort study. A total of 200 head CT scans were reviewed, subdivided into five equal age subgroups (0-4.99; 5-7.99; 8-10.99; 11-13.99; 14-17 years), with an equal male to female ratio. Different subgroups were randomly assigned to two senior residents (100 CTs each). A senior rhinologist and radiologist were randomly selected to review 100 CTs each. Consensus was reached after a joint review. Each CT was evaluated for the presence of sinuses and the following variations: deviated septum, frontoethmoidal, infraorbital, posterior-ethmoid cells (Kuhn, Haller, and Onodi cells, respectively) and concha bullosa. Definitions were made according to the European Position on Rhinosinusitis 2012. RESULTS Gender did not affect sinus development or anatomical variations. The frontal and sphenoid sinuses were significantly less developed in the 0-4.99 years group. The point prevalence of concha bullosa and deviated septum significantly increased with age. The point prevalence of Haller cells demonstrated borderline significance among age groups, with children 0-4.99 demonstrating the lowest point prevalence. A significant association was found between the existence of Haller cells to Kuhn and Onodi cells. CONCLUSIONS Anatomical variations should be expected in the pediatric population. Familiarity with their point prevalence and associations may assist pediatric endoscopic sinus surgery planning.
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Affiliation(s)
- O Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - M Adi
- Department of Radiology, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Y Shapira-Galitz
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - D Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - M Warman
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
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Hershkovitz F, Shirley L, Cohen O, Zilberman U. The effect of cerebral palsy on neonatal line thickness and enamel components. Arch Oral Biol 2019; 104:119-122. [DOI: 10.1016/j.archoralbio.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/30/2019] [Accepted: 06/02/2019] [Indexed: 11/26/2022]
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Namazov A, Gemer O, Bart O, Cohen O, Vaisbuch E, Kapustian V, Ben-Arie A. Effect of Menopausal Status on the Diagnosis of Endometrial Polyp. Journal of Obstetrics and Gynaecology Canada 2019; 41:926-929. [DOI: 10.1016/j.jogc.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
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Alrasheed N, Lee L, Ghorani E, Cohen O, Chavda S, Henry J, Furness A, Chin M, Galas-Filipowicz D, Conde L, De-Silva D, Quezada S, Yong K. PF563 MARROW INFILTRATING T-REGULATORY CELLS ASSOCIATE WITH PD-1 EXPRESSING CD4 EFFECTOR CELLS AND INFERIOR OUTCOMES IN PATIENTS UNDERGOING NOVEL-AGENT REGIMENS FOR NEWLY DIAGNOSED MULTIPLE MYELOMA (MM). Hemasphere 2019. [DOI: 10.1097/01.hs9.0000560544.93776.95] [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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17
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Sidorenko P, Dikopoltsev A, Zahavy T, Lahav O, Gazit S, Shechtman Y, Szameit A, Tannor DJ, Eldar YC, Segev M, Cohen O. Improving techniques for diagnostics of laser pulses by compact representations. Opt Express 2019; 27:8920-8934. [PMID: 31052703 DOI: 10.1364/oe.27.008920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
We propose and demonstrate, numerically and experimentally, use of sparsity as prior information for extending the capabilities and performance of techniques and devices for laser pulse diagnostics. We apply the concept of sparsity in three different applications. First, we improve a photodiode-oscilloscope system's resolution for measuring the intensity structure of laser pulses. Second, we demonstrate the intensity profile reconstruction of ultrashort laser pulses from intensity autocorrelation measurements. Finally, we use a sparse representation of pulses (amplitudes and phases) to retrieve measured pulses from incomplete spectrograms of cross-correlation frequency-resolved optical gating traces.
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Cohen O, Buendia-Buendia J, Wander S, Nayar U, Mao P, Waks A, Kim D, Freeman S, Adalsteinsson V, Helvie K, Livitz D, Rosebrock D, Leshchiner I, Dellostritto L, Garrido-Castro A, Jain E, Periyasamy S, Mackichan C, Lloyd M, Marini L, Krop I, Garraway L, Getz G, Winer E, Lin N, Wagle N. Abstract PD9-02: Evolutionary analysis of 462 serial metastatic biopsies from 208 patients with estrogen receptor-positive (ER+) metastatic breast cancer (MBC) using whole exome sequencing (WES). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd9-02] [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: While great strides have been made in the treatment of ER+ MBC, therapeutic resistance is nearly universal. The genomic evolution of ER+ breast cancer in the metastatic setting under the selective pressure of multiple lines of therapies is not well understood. To address this, we analyzed the clonal dynamics of serial metastatic samples (mets) to evaluate how tumors evolve and to identify acquired resistance mechanisms.
Methods: We performed WES on 462 clinically annotated samples from 208 patients (pts) with ER+ MBC, including 67 primary tumor biopsies, 229 metastatic biopsies and 160 blood samples (cfDNA). Pts with multiple mets included cases with temporally concordant metastatic tumor and blood samples (48 pts) and cases with serial mets obtained over the course of treatment in the metastatic setting (69 pts). Treatments given between the serial mets included CDK4/6 inhibitors (23 pts), and selective estrogen receptor degraders (19 pts), among others.
Results: In the temporally-concordant mets, we found that cfDNA mutations (muts) largely overlap with muts found in tumor biopsies, capturing >85% of clonal tumor muts. However, we observed a higher level of heterogeneity in cfDNA compared to biopsies (p.value< 1.05e-19, Welch test) and a subset of high-confidence muts that were only detected in cfDNA, including in clinically important genes such as ESR1, PIK3CA, KRAS, and ERBB2. Analysis of serial mets was used to elucidate the evolutionary dynamics within the metastatic setting under the selective pressure of treatment. The median duration between mets was 112 days and the median number of inter-biopsy unique treatments was two. Most tumors continued to evolve within the metastatic setting, with 50 out of 69 pts (72%) acquiring a meaningful sub-clone (50% increase in relative cancer cell fraction) and 31 out of 69 (45%) acquiring muts in known cancer genes, including a subset acquiring a plausible resistance alteration such as alterations that dysregulate ER (5 out of 69 pts, 7%; ESR1 mut, FOXA1 amplification (amp), NCOR1 bi-allelic deletion (del)), ERBB (4%; ERBB2 amp, ERBB3 mut), RAS (4%; KRAS mut, NRAS amp, NF1 del), FGF/FGFR (12%; FGFR2 mut, FGFR1/2 amp, FGF3 amp), and cell cycle (13%; RB1 del, CDK4 amp, AURKA amp, CDKN2A del). Finally, in pts who had multiple mets, we observed several cases of evolutionary convergence toward equivalent resistance mechanisms including convergent RB1 loss as a mechanism of resistance to a CDK4/6 inhibitor and convergent BRCA2 reversion following resistance to a PARP inhibitor.
Conclusions: This study demonstrates that ER+ MBC continues to evolve under the selective pressure of treatments in the metastatic setting. These findings elucidate the challenge of studying high complexity and heavily treated tumors, while also highlighting some commonalities in the evolutionary trajectories selected by these treatments. The multiplicity of clinically relevant genomic alterations acquired in these advanced stages highlights the need for serial biopsies and the potential to inform post-progression therapeutic choices through targeting the acquired dependencies in post-progression tumors.
Citation Format: Cohen O, Buendia-Buendia J, Wander S, Nayar U, Mao P, Waks A, Kim D, Freeman S, Adalsteinsson V, Helvie K, Livitz D, Rosebrock D, Leshchiner I, Dellostritto L, Garrido-Castro A, Jain E, Periyasamy S, Mackichan C, Lloyd M, Marini L, Krop I, Garraway L, Getz G, Winer E, Lin N, Wagle N. Evolutionary analysis of 462 serial metastatic biopsies from 208 patients with estrogen receptor-positive (ER+) metastatic breast cancer (MBC) using whole exome sequencing (WES) [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 PD9-02.
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Affiliation(s)
- O Cohen
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - J Buendia-Buendia
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - S Wander
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - U Nayar
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - P Mao
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - A Waks
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - D Kim
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - S Freeman
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - V Adalsteinsson
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - K Helvie
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - D Livitz
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - D Rosebrock
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - I Leshchiner
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - L Dellostritto
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - A Garrido-Castro
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - E Jain
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - S Periyasamy
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - C Mackichan
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - M Lloyd
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - L Marini
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - I Krop
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - L Garraway
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - G Getz
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - E Winer
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - N Lin
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - N Wagle
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
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Jain E, Kim D, Buendia JB, Cohen O, Sousa RB, Anastasio E, Dunphy M, McGillicuddy M, Stoddard R, Balch S, Thomas B, Di Lascio S, Tomson BN, Nguyen C, Painter C, Wagle N. Abstract PD9-03: The genomic landscape of de novo metastatic breast cancer (MBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd9-03] [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 5-10% of newly diagnosed breast cancers (BC) are de novo MBC, which means that metastatic disease was identified at the time of initial diagnosis. Patients with de novo MBC are underrepresented in currently available genomic studies. In The Cancer Genome Atlas (TCGA) dataset, only 15 out of ˜980 BC patients can be classified as having de novo MBC. The objective of this study is to analyze the genomic landscape of de novo MBC and to study the genomic differences of this cohort with early stage BC. To enhance our ability to study de novo MBC, we utilized data from the Metastatic Breast Cancer Project (MBCproject), a patient-partnered research project that aims to generate a large public database of clinical, genomic, and patient reported data (PRD) from patients with MBC.
Methods: We defined de novo MBC as patients diagnosed with metastatic disease less than 4 months after their initial diagnosis with BC.Out of 127 patients in the MBCproject with publicly released whole exome sequencing (WES) data, we identified 33 patients with de novo MBC. We combined this data with 15 de novo MBC patients in TCGA. For patients with de novo MBC with multiple tumor biopsies available, we used WES from breast biopsies to enable appropriate comparison to the early stage biopsies. Somatic mutations were evaluated and significantly recurring genes were identified using MutSig2CV. We compared the mutations found in the de novo cohort with early stage tumors. 10 patients in the de novo MBC cohort had paired simultaneous primary and metastatic biopsies; genomic alterations in these samples were compared. Finally, we used RNA sequencing data to compare cytolytic signatures among the de novo and early stage biopsies.
Results: Among the 48 patients analyzed the receptor subtype distribution was: HR+/HER2-(23), HR+/HER2+(13), HR-/HER2+(2), HR-/HER2-(3), HR+/HER2 unknown(5), and HR-/HER2 unknown(2). Histology subtype distribution was as follows: IDC(39), MDLC(6), ILC(2) and Other (1). Significantly recurrent genes in the de novo MBC cohort (q<0.1) included TP53(27%), PIK3CA(30%), CDH1(8%) and MAP3K1(11%). Mutations in PTEN, EGFR, and MDM4 were significantly enriched (p <0.05) in the de novo cohort when compared to early stage BC Evolutionary analysis of paired primary and metastatic biopsies for de novo MBC patients demonstrated the presence of shared clonal mutations, indicating that these were highly evolutionarily related. RNA-seq immune cytolytic signature was downregulated in de novo MBC as compared to early stage BC (p <0.2).
Gene% Mutation Rate in De Novo MBC (N=48)% Mutation rate in Early Stage BC (N= 997)p-valuePTEN10.403.510.0324EGFR6.250.500.00435MDM44.170.300.0189
Conclusions: Our initial results highlight genomic differences between de novo MBC and early stage BC, including increased frequency of PTEN, EGFR, and MDM4 mutations. Enrichment of PTEN mutations (implicated in tumor immune surveillance), and downregulation of cytolytic signature potentially suggests that de novo MBC may have immunosuppressive tumor microenvironment. To date, ˜1200 patients with self-reported de novo MBC have registered for the MBCproject. We anticipate that additional study of genomic and clinical data from these patients will greatly improve our understanding of de novo MBC.
Citation Format: Jain E, Kim D, Buendia JB, Cohen O, Sousa RB, Anastasio E, Dunphy M, McGillicuddy M, Stoddard R, Balch S, Thomas B, Di Lascio S, Tomson BN, Nguyen C, Painter C, Wagle N. The genomic landscape of de novo metastatic breast cancer (MBC) [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 PD9-03.
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Affiliation(s)
- E Jain
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - D Kim
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - JB Buendia
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - O Cohen
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - RB Sousa
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - E Anastasio
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - M Dunphy
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - M McGillicuddy
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - R Stoddard
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - S Balch
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - B Thomas
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - S Di Lascio
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - BN Tomson
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - C Nguyen
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - C Painter
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
| | - N Wagle
- The Broad Institute of MIT and Harvard, Cambridge, MA; Dana Farber Cancer Institute, Boston, MA
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Reitblat O, Lerman TT, Cohen O, Reitblat T. The Effect of Prednisone on Tuberculin Skin Test Reaction in Patients with Rheumatoid Arthritis. Int J Rheumatol 2018; 2018:2586916. [PMID: 30420888 PMCID: PMC6215561 DOI: 10.1155/2018/2586916] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/29/2018] [Accepted: 10/03/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the correlation between prednisone and methotrexate (MTX) treatment duration and dosage with the TST induration diameter of the TST reaction among rheumatoid arthritis (RA) patients. METHOD We retrospectively analyzed consecutive cases of RA patients who were TNF-i therapy candidates. TST measurements, prednisone and methotrexate dosages, and treatment durations were recorded. A control group was randomly selected from healthy subjects. We compared TST reaction size between the following three groups: RA patients with current prednisone treatment, RA prednisone naïve patients, and healthy individuals. RESULTS Our study sample comprised 43 RA patients with prednisone treatment, 22 prednisone naïve patients, and 195 healthy subjects. There was no significant difference in mean TST between the groups (5.3±6.6, 7.8±6.2, and 7.6±7.0, respectively, p=0.149). No correlation was noted between TST size and prednisone u-y (r=0.229, p=0.140) or methotrexate u-y in patients with and without prednisone therapy (r=0.219, p=0.158; and r=-0.293, p=0.186, respectively). CONCLUSIONS Our results show that the TST reaction size among RA patients may not be affected by prednisone therapy. In addition, the TST reaction of RA patients may present similarly to that of healthy individuals. Therefore, we suggest that the criterion of a TST reaction of 5 mm to define latent TB infection in our population should be reevaluated.
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Affiliation(s)
- Olga Reitblat
- Barzilai Medical Center, Ashkelon, Israel
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Tsahi T. Lerman
- Barzilai Medical Center, Ashkelon, Israel
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Ornit Cohen
- Barzilai Medical Center, Ashkelon, Israel
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Tatiana Reitblat
- Barzilai Medical Center, Ashkelon, Israel
- Ben Gurion University of the Negev, Beer-Sheva, Israel
- Rheumatology Unit, Barzilai Medical Center, Ashkelon, Israel
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Lakstein D, Cohen O, Daglan E, Haimovich Y, Tan Z. Mortality and Function after Hip Fractures in Different Ethnic Populations in Israel. Isr Med Assoc J 2018; 20:553-556. [PMID: 30221868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Mortality and decrease in function after hip fracture are significantly related to patient factors including age, gender, co-morbidities, and mental status. Several studies demonstrated ethnic disparities in incidence, mortality, and functional outcome after hip fractures in the United States. OBJECTIVES To assess the relationship between ethnicity and hip fracture incidence and outcomes of mortality, functional change, and perioperative complications in the Israeli population. METHODS We reviewed our institutional hip fracture registry for all patients from 2014-2015. Patients with incomplete data, < 60 years of age, or pathologic and periprosthetic fractures were excluded. Our study comprised 693 patients. Ethnicity was based on country of birth. Specifically, for those born in Israel, the nationality of either Jewish or Arab was further dichotomized. Perioperative complications, mortality, and mobility status at 1 year follow-up were recorded. The ethnicities of 27,130 patients admitted to the medicine and surgical wards during the same time interval served as a control group for the hip fracture cohort. RESULTS Immigrants from Europe and America had the highest incidence of hip fractures. Fracture types varied in incidence in groups with 70% of extracapsular hip fractures occurring in Arabs and immigrants from Eastern countries, compared to 60% in immigrants from Western countries and the former Soviet Union. Mortality, perioperative complications, and mobility at 1 year were similar in all ethnic groups. CONCLUSIONS Our study demonstrated significant differences in incidence and fracture characteristic among ethnicities, but no difference in patient outcome. These findings differed from the available North American studies.
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Affiliation(s)
- Dror Lakstein
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ornit Cohen
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Efrat Daglan
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
| | - Yaron Haimovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
| | - Zachary Tan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Grin L, Mizrachi Y, Cohen O, Lazer T, Liberty G, Meltcer S, Friedler S. Does progesterone to oocyte index have a predictive value for IVF outcome? A retrospective cohort and review of the literature. Gynecol Endocrinol 2018; 34:638-643. [PMID: 29373930 DOI: 10.1080/09513590.2018.1431772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The potential adverse effect of Serum progesterone (SP) elevation on the day of hCG administration is a matter of continued debate. Our study aimed to evaluate the relative value of progesterone to a number of aspirated oocytes ratio (POI) to predict clinical pregnancy (CP) and live birth (LB) in fresh IVF cycles and to review the relevant literature. A retrospective analysis of GnRH Antagonist IVF-ET cycles. POI was calculated by dividing the SP on the day of hCG by the number of aspirated mature oocytes. A multivariate logistic regression analysis was performed to evaluate the predictive value of POI for CP and LB. Cycle outcome parameters included clinical pregnancy, live-birth and miscarriage. A total of 2,693 IVF/ICSI cycles were analyzed. POI was inversely associated with CP adjusted OR 0.063 (95% CI 0.016-0.249, p < .001) and with LB adjusted OR 0.036 (95% CI 0.007-0.199, p < .001). For prediction of LB, the area under the curve (AUC) was 0.68 (95% CI 0.64-0.71, p < .001) for the POI model. POI above the 90th percentile with a value of 0.36 ng/mL/oocyte results in CP and LB rates of 8.0 and 5.9%, respectively. POI is a simple index for the prediction of IVF-ET cycle outcomes, it can advocate a limit above which embryo transfer should be reconsidered.
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Affiliation(s)
- Leonti Grin
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Yossi Mizrachi
- b Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Sackler Faculty of Medicine , Tel Aviv University , Holon , Israel
| | - Ornit Cohen
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Tal Lazer
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Gad Liberty
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Simion Meltcer
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Shevach Friedler
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
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Debi R, Slamowicz E, Cohen O, Elbaz A, Lubovsky O, Lakstein D, Tan Z, Atoun E. Acetabular cup orientation and postoperative leg length discrepancy in patients undergoing elective total hip arthroplasty via a direct anterior and anterolateral approaches. BMC Musculoskelet Disord 2018; 19:188. [PMID: 29879934 PMCID: PMC5992835 DOI: 10.1186/s12891-018-2097-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/17/2018] [Indexed: 02/08/2023] Open
Abstract
Background Total hip arthroplasty (THA) is considered a successful surgical procedure. It can be performed by several surgical approaches. Although the posterior and anterolateral approaches are the most common, there has been increased interest in the direct anterior approach. The goal of the present study is to compare postoperative leg length discrepancy and acetabular cup orientation among patients who underwent total hip arthroplasty through a direct anterior (DAA) and anterolateral (ALA) approaches. Methods The study included 172 patients undergoing an elective THA by a single surgeon at our institution within the study period. Ninety-eight arthroplasties were performed through the ALA and 74 arthroplasties through the DAA. Preoperative planning was performed for all patients. Assessment of the two groups included the following postoperative parameters: abduction angle, cup anteversion angle and leg length discrepancy (LLD). Additional analysis was done to evaluate component positioning by comparing deviation from the Lewinnek zone of safety in both approaches. Results For the DAA the absolute LLD was 11 mm, ranging from -6 mm to 5 mm. For the ALA, the absolute LLD was 36 mm, ranging from -22 mm to 14 mm. None of the DAA patients had an absolute LLD greater than 6 mm. Comparatively, 7.4% of the ALA group exceeded 6 mm of LLD in addition to 2.1% with LLD greater than 10 mm. 15% of the ALA group resided out of the Lewinnek abduction zone compared to 3% of the DAA group (P = 0.016). 17% of the ALA group were out of the Lewinnek anteversion zone as opposed to 8% of the DAA group (P = 0.094). Conclusion Our study demonstrates good component positioning outcomes and LLD values in patients following THA through the DAA compared to the ALA.
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Affiliation(s)
- Ronen Debi
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Evyatar Slamowicz
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Ornit Cohen
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Avi Elbaz
- AposTherapy Research Group, Herzelyia, Israel
| | - Omri Lubovsky
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Dror Lakstein
- Department of Orthopaedic Surgery, Wolfson Medical Center , Holon, Israel
| | - Zachary Tan
- Department of Orthopaedic Surgery, Wolfson Medical Center , Holon, Israel
| | - Ehud Atoun
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel. .,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel.
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Cohen O, Gamliel A, Katan J, Kurzbaum E, Riov J, Bar P. Controlling the seed bank of the invasive plant Acacia saligna: comparison of the efficacy of prescribed burning, soil solarization, and their combination. Biol Invasions 2018. [DOI: 10.1007/s10530-018-1738-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Abstract
Approximately 70% of breast cancers express the estrogen receptor (ER), and estrogen signaling drives breast cancer cell growth and progression. ER-directed therapies are commonly used to treat ER+ breast cancer and have improved survival for patients, yet resistance to those therapies inevitably occurs. Mutations in the estrogen receptor itself occur in ∼25-30% of patients with ER+ metastatic breast cancer that has developed resistance to aromatase inhibitors. Beyond these ER mutations, other resistance mechanisms are not well described. Moreover, clinical mechanisms of resistance to another class of ER-targeted agents, selective estrogen receptor degraders (SERDs), such as fulvestrant have not been clearly identified.
Here we report two FGFR2 mutations identified in patients with resistant ER+ metastatic breast cancer, N550K and M538I. N550K is a well-known activating FGFR2 mutation; M538I stabilizes the active kinase conformation and it has not previously been described in breast cancer. When expressed in ER+ T47D cells, FGFR2 M538I and N550K led to resistance to fulvestrant, and the CDK4/6 inhibitor palbociclib and the combination of the two agents. FGFR2 M538I induced hyperactivity of p-FRS2, p-ERK and p-AKT, which is higher than wildtype FGFR2 and comparable to other known activating mutations N550K and K660N.
In addition, overexpression of M538I mutant reduced sensitivity to FGFR inhibitors PD173074 and dovitinib in T47D cells, suggesting M538I is also functionally activating. Due to the hyperactive downstream signaling elicited by the mutation, cells overexpressing FGFR2 M538I achieved optimal growth in the presence of low dose of FGFR inhibitor. Under such conditions, FGFR2 M538I conferred more potent resistance to fulvestrant as compared to wildtype FGFR2. However, drug resistance resulting from M538I mutant can be fully resensitized to fulvestrant and/or palbociclib with high dose of FGFR inhibitors.
In summary, we have identified activating FGFR2 mutations (M538I and N550K) in ER+ breast cancer patients, which may contribute to the development of resistance to SERDs and CDK4/6 inhibitors. Additional FGFR2 mutations have been recently identified in other cohorts of patients with resistant ER+ metastatic breast cancer, suggesting that this may be a clinical mechanism of resistance in some patients. Patients with activating FGFR2 mutations may benefit from the treatment with an FGFR inhibitor in combination with SERDs and CDK4/6 inhibitors.
Citation Format: Mao P, Kusiel J, Cohen O, Wagle N. The role of FGF/FGFR axis in resistance to SERDs and CDK4/6 inhibitors in ER+ breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD4-01.
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Affiliation(s)
- P Mao
- Dana Farber Cancer Institute; Broad Institute
| | - J Kusiel
- Dana Farber Cancer Institute; Broad Institute
| | - O Cohen
- Dana Farber Cancer Institute; Broad Institute
| | - N Wagle
- Dana Farber Cancer Institute; Broad Institute
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Weinberg A, Granieri M, Cohen O, Bluebond-Langner R, Levine J, Zhao L. 027 Robotic-Assisted Vaginectomy, Mobilization of Vaginal Mucosa for Urethral Lengthening and a Gracilis Muscle Flap for Phalloplasty: A Novel Technique for Female-to-Male Genital Reconstruction. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.046] [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: 10/18/2022]
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Atoun E, Gilat R, van Tongel A, Pradhan R, Cohen O, Rath E, Levy O. Intraobserver and interobserver reliability of the Copeland-Levy classification for arthroscopic evaluation of subacromial impingement. J Shoulder Elbow Surg 2017; 26:2167-2172. [PMID: 28919000 DOI: 10.1016/j.jse.2017.07.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/08/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Defining a simple and reliable classification for acromial and bursal impingement lesions is necessary to standardize terminology, to improve communication, and to allow better evaluation of the proper treatment of impingement lesions and rotator cuff tears. The purpose of this study was to assess orthopedic surgeons' intraobserver and interobserver reliability of the Copeland-Levy classification. METHODS Six fellowship-trained orthopedic surgeons reviewed shoulder arthroscopy videos of 69 consecutive patients who underwent shoulder arthroscopy for rotator cuff tear repair or subacromial decompression. The surgeons were asked to classify impingement lesions according to the Copeland-Levy classification. One month afterward, the surgeons were requested to repeat the evaluation of the same impingement lesions. Intraobserver reliability was calculated using Cohen's weighted κ. Interobserver reliability was calculated using Kendall's W. RESULTS Overall intraobserver reliability for acromial and bursal lesions was κ = 0.86 (95% confidence interval, 0.82-0.9) and κ = 0.97 (95% confidence interval, 0.95-0.98), respectively. Interobserver reliability for acromial and bursal lesions was W = 0.87 and W = 0.92, respectively. CONCLUSION Intraobserver and interobserver reliability of the Copeland-Levy classification among senior orthopedic surgeons is excellent. Hence, we suggest the Copeland-Levy classification be used to standardize terminology of the subacromial impingement lesion.
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Affiliation(s)
- Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Barzilai Medical Center Campus, Ashkelon, Israel.
| | - Ron Gilat
- Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Be'er Ya'akov, Israel
| | - Alexander van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Riten Pradhan
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Ornit Cohen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ehud Rath
- Orthopaedic Division, Tel Aviv Souraski Medical Center, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
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Kovalyuk N, Kaiserman I, Mimouni M, Cohen O, Levartovsky S, Sherbany H, Mandelboim M. Treatment of adenoviral keratoconjunctivitis with a combination of povidone-iodine 1.0% and dexamethasone 0.1% drops: a clinical prospective controlled randomized study. Acta Ophthalmol 2017; 95:e686-e692. [PMID: 28342227 DOI: 10.1111/aos.13416] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 08/22/2016] [Accepted: 01/13/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the efficacy of combination povidone-iodine (PVP-I) 1.0% eyedrops and dexamethasone 0.1% eyedrops in the treatment of adenoviral keratoconjunctivitis. MATERIALS AND METHODS In a prospective, randomized, controlled, double-blinded clinical trial patients with recent adenoviral keratoconjunctivitis (diagnosed clinically and confirmed by PCR), we randomly divided into three treatment groups: study group - received PVP-I 1.0% and dexamethasone 0.1%, control 1 group - received dexamethasone 0.1% and control 2 group - received lubricating eyedrops (hypromellose 0.3%). The treatment was administered four times a day in each group. All patients were examined and filled a questionnaire before treatment and on the 3rd, 5th and 7th days of treatment. RESULTS We included in the study 78 eyes (26 in each group). Adenovirus type 8 was the most common pathogen (83% of cases). The fastest improvement in patients red eyes, discharge, superficial punctate keratitis and pseudomembranes was observed in the study group (p < 0.001). Those patients reached a near complete recovery in 5-7 days, which was also confirmed by reduction in Adenovirus titres by PCR. The slowest improvement was in the control 2 group. Subepithelial infiltrates (SEI) were observed in 44% of the control 1 group, 20% of the control 2 group and in 0% of the study group. The rate of reduction in Adenovirus titres was the slowest in the control 1 group. CONCLUSION The combination of PVP-I 1.0% and dexamethasone 0.1% four times a day can reduce symptoms and expedite recovery in epidemic keratoconjunctivitis patients.
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Affiliation(s)
- Natalya Kovalyuk
- Department of Ophthalmology; Barzilai Medical Center; Ashkelon Israel
| | - Igor Kaiserman
- Department of Ophthalmology; Barzilai Medical Center; Ashkelon Israel
- Department of health science; Ben Gurion University; Be'er Sheva Israel
| | - Michael Mimouni
- Department of Ophthalmology; Rambam Health Care Campus; Haifa Israel
| | - Ornit Cohen
- Department of Ophthalmology; Barzilai Medical Center; Ashkelon Israel
| | - Shmuel Levartovsky
- Department of Ophthalmology; Barzilai Medical Center; Ashkelon Israel
- Department of health science; Ben Gurion University; Be'er Sheva Israel
| | - Hilda Sherbany
- Central Virology Laboratory; Ministry of Health; Chaim Sheba Medical Center; Ramat-Gan Israel
| | - Michal Mandelboim
- Central Virology Laboratory; Ministry of Health; Chaim Sheba Medical Center; Ramat-Gan Israel
- Department of Epidemiology and Preventive Medicine; School of Public Health; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
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Abstract
Our aim was to examine the influence of BMI on the live-birth rate following IVF/ICSI and evaluate its specific contribution among other factors thus enabling accurate reproductive policy development. All patients that underwent IVF/ICSI at our center during January 2012-July 2015 were included in this retrospective study. A total of 1654 ICSI cycles were divided into four groups according to the patient's BMI (kg/m2): group I (normal weight): <25 (943 cycles); group II (overweight): 25-30 (403 cycles); group III (obese): 30-35 (212 cycles); group IV (morbid obesity): >35 (96 cycles). Comparing the four groups of BMI, mean age and number of previous ART cycles was significantly lower in group I compared to groups II, III and IV. Length of treatment was significantly shorter in group I compared to groups II, III and IV. Ovarian response to COH was comparable in terms of mean estradiol and progesterone levels on the day of hCG administration mean number of oocytes retrieved, fertilized and number of embryos transferred. Endometrial thickness was significantly lower in group IV. Outcome measures, such as implantation rate, clinical pregnancy rate (CPR) per cycle and per ET, as well as live-birth rates did not differ significantly between the groups, although in group IV LBR per cycle and per ET was lower. Multivariate logistic regression stepwise analysis found a significant correlation between age and BMI but did not find correlation between BMI and clinical pregnancy (p = 0.436) or LB (p = 0.206). The results of our relatively large retrospective study did not demonstrate a significant impact of BMI on the ART cycle outcome. Therefore, BMI should not be a basis for IVF treatment denial.
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Affiliation(s)
- S Friedler
- a Infertility and IVF Unit , Barzilai University Medical Center , Ashkelon , Israel
- b Faculty of Health Sciences, Ben Gurion University of the Negev , Beer-Sheva , Israel
| | - O Cohen
- c Research & Development Authority , Barzilai University Medical Center , Ashkelon , Israel
| | - G Liberty
- a Infertility and IVF Unit , Barzilai University Medical Center , Ashkelon , Israel
- b Faculty of Health Sciences, Ben Gurion University of the Negev , Beer-Sheva , Israel
| | - B Saar-Ryss
- a Infertility and IVF Unit , Barzilai University Medical Center , Ashkelon , Israel
- b Faculty of Health Sciences, Ben Gurion University of the Negev , Beer-Sheva , Israel
| | - S Meltzer
- a Infertility and IVF Unit , Barzilai University Medical Center , Ashkelon , Israel
- b Faculty of Health Sciences, Ben Gurion University of the Negev , Beer-Sheva , Israel
| | - T Lazer
- a Infertility and IVF Unit , Barzilai University Medical Center , Ashkelon , Israel
- b Faculty of Health Sciences, Ben Gurion University of the Negev , Beer-Sheva , Israel
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Shoffel-Havakuk H, Cohen O, Slavin M, Haimovich Y, Halperin D, Lahav Y. Intravenous opioid drug abuse as an independent risk factor for supraglottic squamous cell carcinoma-A case-control study. Clin Otolaryngol 2017; 43:456-462. [PMID: 28950046 DOI: 10.1111/coa.12990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Intravenous opioid drug abuse (IVDA) was previously correlated with laryngeal cancer. However, discrimination of this correlation by anatomical subsites has not yet been described. In this study, we aim to further establish the association between IVDA and laryngeal squamous cell carcinoma (SCC) and to indicate the laryngeal subsites that are predisposed for this correlation. DESIGN A retrospective matched case-control study. SETTING AND PARTICIPANTS Patients diagnosed with supraglottic SCC (SG-SCC) between 1996 and 2016 treated in a tertiary academic referral centre were enrolled to the case group. The control group comprised of matched patients diagnosed with glottis SCC (G-SCC). Matching was based on gender, age and socio-economic rank. MAIN OUTCOME MEASURES Variables studies as risk factors included the following: smoking, alcohol consumption, history of IVDA and infectious diseases. The variables were tested for association with the 2 groups and with each other. RESULTS Forty-eight patients with SG-SCC were matched with 48 patients with G-SCC. IVDA rates significantly increased among patients with SG-SCC. Of the SG-SCC group, 18.8% had a positive history for IVDA compared with 2.1% of the G-SCC (P = .008). A history of IVDA was found to be a risk factor for SG-SCC, independent of smoking, excessive alcohol and socio-economic status. The odds ratio for patients with an IVDA history to have SG-SCC relatively to G-SCC was 10.846 (95% CI: 1.3-89.4). CONCLUSIONS Intravenous opioid drug abuse represents an independent risk factor for SG-SCC. The pathogenesis should be investigated not just as a risk factor, as opioids are commonly used for pain management in oncologic patients.
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Affiliation(s)
- H Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel.,Department of Otolaryngology Head and Neck Surgery, USC Voice Center, University of Southern California, Los Angeles, CA, USA
| | - O Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - M Slavin
- Department of General Surgery B, Meir Medical Center, Kfar Saba, Israel
| | - Y Haimovich
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - D Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Y Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel
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Cohen O, Raz Yarkoni T, Lahav Y, Azoulay O, Halperin D, Yehuda M. Surgeon-performed thyroid ultrasound-proving utility and credibility in selecting patients for fine needle aspiration according to the American thyroid association guidelines. A retrospective study of 500 patients. Clin Otolaryngol 2017; 43:267-273. [PMID: 28892590 DOI: 10.1111/coa.12984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Abstract
DESIGN Case series with chart review. SETTING Single academic centre. PARTICIPANTS The data of all patients who underwent surgeon-performed ultrasound (SUS) between 7/2009 and 9/2012 were retrospectively reviewed. MAIN OUTCOME MEASURES A correlation between sonographic features and a non-benign cytology\malignant pathology. RESULTS Four hundred ninety-eight nodules were included. Solid texture, irregular margins, hypo-echogenicity and intranodular vascularity were significantly associated with malignancy when benign to non-benign cytology was compared, and when compared to malignant pathology. Lack of suspicious features was significantly associated with benign lesions, with a negative predictive value of 94%. Except for taller than wider shape, malignancy odds ratio was significantly higher for known suspicious features, reaching 4.81 for irregular borders (CI 2.42-9.55, P < .001). CONCLUSIONS SUS has proven to be a reliable and consistent tool to assess the thyroid nodule risk stratification. Surgeons should recognise the potential of this tool and its implementation.
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Affiliation(s)
- O Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - T Raz Yarkoni
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - Y Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - O Azoulay
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - D Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - M Yehuda
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel.,Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Slutzkey S, Cohen O, Lauritano D, Moses O, Ormianer Z, Tal H, Kolerman R, Carinci F, Matalon S. Temperature changes of one-piece implants during the setting of acrylic resin temporary crown. The effect of implant diameter. An in vitro study. J BIOL REG HOMEOS AG 2017; 31:53-60. [PMID: 28691454] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this work is to evaluate changes in temperature of one-piece titanium implant surface during the setting of acrylic resin temporary crowns and to correlate thermal changes to implant diameter. Thirty-three one-piece implants (ARRP, Alpha-Biotec) were divided into 3 groups according to diameter size (G1=3 mm, G2=3.3 mm, G3=3.6 mm). Implants were mounted on an acrylic glass apparatus. Thermocouples were positioned at the most coronal thread. Lower incisor temporary polycarbonate crowns were filled with 80 μL of self-curing acrylic resin and positioned immediately on the implant abutment. Thermal changes of the implant surface were recorded continuously for 10 min. Data were statistically analyzed using one-way analysis of variance. The mean initial temperature (C0) of groups G1, G2 and G3 was similar (24.79±0.78ºC, 25.26±0.63ºC, 24.97±1.06ºC, respectively). The setting of the acrylic resin temporary crown resulted in a significant increase in the implant surface temperature of all groups. The mean thermal amplitude (ΔC) for groups G1, G2 and G3 were 6.79±1.02ºC, 6.61±0.94ºC, 6.65±1.26ºC, respectively. The mean time to maximum temperature (Tmax) for groups G1, G2 and G3 were 337.38±42.91 sec, 324.69±41.46 sec and 317.98±37.91 sec respectively (P>0.05). Direct application of auto-polymerizing resin to the titanium abutment of one-piece implants significantly increased the cervical implant surface temperature. Implant diameter did not influence the temperature changes.
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Affiliation(s)
- S Slutzkey
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - O Cohen
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - D Lauritano
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - O Moses
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Z Ormianer
- Department of Oral Rehabilitation, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H Tal
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - R Kolerman
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - F Carinci
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - S Matalon
- Department of Oral Rehabilitation, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Mao P, Quartey Q, Cohen O, Piccioni F, Wagle N. Abstract P3-03-08: A large-scale functional screen to identify resistance mechanisms to selective estrogen receptor degraders fulvestrant and GDC-810 in ER+ breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-03-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Therapies that target the estrogen receptor provide clinical benefit and improved survival for patients with estrogen receptor-positive (ER+) breast cancer, yet drug resistance remains a challenging problem, leading to disease relapse and mortality. In recent years, the selective estrogen receptor degrader (SERD) fulvestrant has become an important therapeutic option for patients with resistant ER+ metastatic breast cancer, and newer oral SERDs such as GDC-810 are currently being tested in clinical trials. The mechanisms of intrinsic and acquired resistance to SERDs remain to be fully elucidated.
We conducted a large-scale lentiviral open reading frame (ORF) screen to identify genes whose overexpression confers drug resistance to either fulvestrant or GDC-810 in the ER+ breast cancer cell line T47D. The lentivral ORF expression library used in this study consists of 16,544 barcoded ORFs, including 2,767 ORFs with mutations. The initial screen yielded 72 genes resulting in resistance to fulvestrant and 85 genes resulting in resistance to GDC-0810, with 44 genes overlapping. The top ranked-genes included multiple genes belonging to the PI3K/Akt, ERbB/HER, and FGF/FGFR pathways as well as genes involved in cell cycle progression.
Fibroblast growth factor receptor 1 (FGFR1) amplifications are frequently observed in patients with ER+ breast cancer, and have previously been implicated in resistance to endocrine therapies. Several FGFs (FGF3, FGF6, FGF10, and FGF22) were among the top-ranked resistance genes for both fulvestrant and GDC-0810, suggesting that activation of the FGFR signaling pathway may render cells resistant to fulvestrant and GDC-810. In the presence of FGF2, overexpression of FGFR1 in ER+ breast cancer cells resulted in resistance to both fulvestrant and GDC-0810. The ability of an FGFR inhibitor to overcome FGFR-mediated resistance to SERDs is being tested. Additional potential resistance genes identified in the ORF screen are also being validated.
In summary, a whole-genome functional resistance screen has identified several candidate genes and pathways that may cause resistance to fulvestrant and GDC-810. Several of these candidates, such as FGFR1, are also found in patients who develop resistance to SERDs, suggesting rational combination therapies to overcome or preempt SERD resistance.
Citation Format: Mao P, Quartey Q, Cohen O, Piccioni F, Wagle N. A large-scale functional screen to identify resistance mechanisms to selective estrogen receptor degraders fulvestrant and GDC-810 in ER+ breast cancer [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 P3-03-08.
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Affiliation(s)
- P Mao
- Dana Farber Cancer Institute, Boston, MA; Broad Institute, Cambridge, MA; Brigham and Women's Hospital, Boston, MA
| | - Q Quartey
- Dana Farber Cancer Institute, Boston, MA; Broad Institute, Cambridge, MA; Brigham and Women's Hospital, Boston, MA
| | - O Cohen
- Dana Farber Cancer Institute, Boston, MA; Broad Institute, Cambridge, MA; Brigham and Women's Hospital, Boston, MA
| | - F Piccioni
- Dana Farber Cancer Institute, Boston, MA; Broad Institute, Cambridge, MA; Brigham and Women's Hospital, Boston, MA
| | - N Wagle
- Dana Farber Cancer Institute, Boston, MA; Broad Institute, Cambridge, MA; Brigham and Women's Hospital, Boston, MA
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Cohen O, Kim D, Oh C, Waks A, Oliver N, Helvie K, Marini L, Rotem A, Lloyd M, Stover D, Adalsteinsson V, Freeman S, Ha G, Cibulskis C, Anderka K, Tamayo P, Johannessen C, Krop I, Garraway L, Winer E, Lin N, Wagle N. Abstract S1-01: Whole exome and transcriptome sequencing of resistant ER+ metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-s1-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: While great strides have been made in the treatment of estrogen receptor-positive (ER+) metastatic breast cancer (MBC), therapeutic resistance invariably occurs. A better understanding of the underlying resistance mechanisms is critical to enable durable control of this disease.
Methods: We performed whole exome sequencing (WES) and transcriptome sequencing (RNA-seq) on metastatic tumor biopsies from 88 patients with ER+ MBC who had developed resistance to one or more ER-directed therapies. For 27 of these patients, we sequenced the treatment-naïve primary tumors for comparison to the resistant specimens. Tumors were analyzed for point mutations, insertions/deletions, copy number alterations, translocations, and gene expression. Detailed clinicopathologic data was collected for each patient and linked to the genomic information.
Results: WES of all metastatic samples demonstrated several recurrently altered genes whose incidence differed significantly from primary, treatment-naïve ER+ breast cancers sequenced in the TCGA study (TCGA). These include ESR1 mutations (n=17, 19.3%; 32.86 fold enrichment, q.value<7.5e-12), CCND1 amplification (n=52, 59.1%; 2.3 fold enrichment, q.value<0.0073), and MAP2K4 biallelic inactivation (n=14, 15.9%; 3.04 fold enrichment, q.value< 0.054).
Comparing to matched primary samples from the same patient, many alterations were found to be acquired in several cases, including for ESR1, ERBB2, PIK3CA, PTEN, RB1, AKT1, and others. Initial analysis of RNA-seq data from metastatic samples (n=59) allowed classification of individual resistance mechanisms into broader resistance modes based on the observed transcriptional state.
Conclusions: We present a genomic landscape of resistant ER+ MBC using WES and RNA-seq. Multiple genes were recurrently altered in these tumors at significantly higher rates than in ER+ primary breast cancer. When compared with matched primary tumors from the same patient, alterations in these and other genes were often found to be acquired after treatment, suggesting a role in resistance to ER-directed therapies and/or metastasis. Potential resistance mechanisms appear to fall into several categories; integrating RNA-seq data may enhance the ability to identify these categories even when genomic alterations are not identified. Multiple clinically relevant genomic and molecular alterations are identified in metastatic biopsies– with implications for choice of next therapy, clinical trial eligibility, and novel drug targets.
Citation Format: Cohen O, Kim D, Oh C, Waks A, Oliver N, Helvie K, Marini L, Rotem A, Lloyd M, Stover D, Adalsteinsson V, Freeman S, Ha G, Cibulskis C, Anderka K, Tamayo P, Johannessen C, Krop I, Garraway L, Winer E, Lin N, Wagle N. Whole exome and transcriptome sequencing of resistant ER+ metastatic breast cancer [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 S1-01.
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Affiliation(s)
- O Cohen
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D Kim
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - C Oh
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - A Waks
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - N Oliver
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - K Helvie
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - L Marini
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - A Rotem
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M Lloyd
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D Stover
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - V Adalsteinsson
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - S Freeman
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - G Ha
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - C Cibulskis
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - K Anderka
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - P Tamayo
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - C Johannessen
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - I Krop
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - L Garraway
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - E Winer
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - N Lin
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - N Wagle
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
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Nayar U, Cohen O, Oh C, Wagle N. Abstract P3-04-08: The role of HER2 mutations in resistance to endocrine therapy in ER+ breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-04-08] [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
Resistance to endocrine therapies in estrogen receptor positive (ER+) metastatic breast cancer is widespread, and understanding the mechanisms whereby these tumors acquire resistance is a critical need. Through whole-exome sequencing of metastatic tumor biopsies from patients with endocrine resistant ER+ metastatic breast cancer, we identified 13 different HER2 mutations, including five in the kinase domain, four in the signaling domain, three in the extracellular domain, and one in the transmembrane region of the protein. Two of the kinase domain mutations (L755S and V777L) have been previously described and shown to be activating and resistant to reversible anti-HER2 targeted therapies; the remaining mutations have not been reported. In several of these patients, whole exome sequencing of a pre-treatment primary tumor did not identify the HER2 mutations seen in the corresponding metastatic tumor, suggesting that they were acquired during therapy. To examine the role of HER2 mutations in endocrine resistance, we generated ER+ breast cancer cell lines (MCF7 and T47D) stably expressing the HER2 mutants observed in our clinical data. Several mutants promoted enhanced growth in charcoal dextran-stripped media, which lacks estradiol and mimics treatment with aromatase inhibitor. In addition, several mutants conferred varying degrees of resistance to fulvestrant and tamoxifen. Taken together, these results suggest that HER2 mutations are associated with acquired resistance to endocrine therapies in patients with ER+ breast cancer. The ability of irreversible anti-HER2 agents as well as other agents that target the HER2 pathway to overcome this resistance is being tested for individual HER2 mutations in vitro. The results from these studies may provide a clinical rationale for therapeutic combination strategies in patients with refractory tumors that have acquired endocrine resistance through HER2 mutations.
Citation Format: Nayar U, Cohen O, Oh C, Wagle N. The role of HER2 mutations in resistance to endocrine therapy in ER+ breast cancer [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 P3-04-08.
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Affiliation(s)
- U Nayar
- Dana-Farber Cancer Institute, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA
| | - O Cohen
- Dana-Farber Cancer Institute, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA
| | - C Oh
- Dana-Farber Cancer Institute, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA
| | - N Wagle
- Dana-Farber Cancer Institute, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA
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Schütz-Fuhrmann I, Castañeda J, Reznik Y, Aronson R, Conget I, Liabat S, Runzis S, de Portu S, Cohen O. Factors affecting the benefit of insulin dose intensification in people with Type 2 diabetes: an analysis from the OpT2mise randomized trial. Diabet Med 2017; 34:291-292. [PMID: 27770589 DOI: 10.1111/dme.13279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/23/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- I Schütz-Fuhrmann
- Department of Endocrinology, City Hospital Hietzing, Vienna, Austria
| | - J Castañeda
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Y Reznik
- Department of Endocrinology, University of Caen Côte de Nacre Regional Hospital Center, Caen, France
| | - R Aronson
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - I Conget
- Diabetes Unit, Endocrinology and Nutrition Department, University Hospital Clinic, Barcelona, Spain
| | - S Liabat
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - S Runzis
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - S de Portu
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - O Cohen
- Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Maulucci G, Cohen O, Daniel B, Sansone A, Petropoulou PI, Filou S, Spyridonidis A, Pani G, De Spirito M, Chatgilialoglu C, Ferreri C, Kypreos KE, Sasson S. Fatty acid-related modulations of membrane fluidity in cells: detection and implications. Free Radic Res 2016; 50:S40-S50. [PMID: 27593084 DOI: 10.1080/10715762.2016.1231403] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Metabolic homeostasis of fatty acids is complex and well-regulated in all organisms. The biosynthesis of saturated fatty acids (SFA) in mammals provides substrates for β-oxidation and ATP production. Monounsaturated fatty acids (MUFA) are products of desaturases that introduce a methylene group in cis geometry in SFA. Polyunsaturated fatty acids (n-6 and n-3 PUFA) are products of elongation and desaturation of the essential linoleic acid and α-linolenic acid, respectively. The liver processes dietary fatty acids and exports them in lipoproteins for distribution and storage in peripheral tissues. The three types of fatty acids are integrated in membrane phospholipids and determine their biophysical properties and functions. This study was aimed at investigating effects of fatty acids on membrane biophysical properties under varying nutritional and pathological conditions, by integrating lipidomic analysis of membrane phospholipids with functional two-photon microscopy (fTPM) of cellular membranes. This approach was applied to two case studies: first, pancreatic beta-cells, to investigate hormetic and detrimental effects of lipids. Second, red blood cells extracted from a genetic mouse model defective in lipoproteins, to understand the role of lipids in hepatic diseases and metabolic syndrome and their effect on circulating cells.
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Affiliation(s)
- G Maulucci
- a Institute of Physics, Università Cattolica del Sacro Cuore , Roma , Italy
| | - O Cohen
- b Institute for Drug Research, Section of Pharmacology, Diabetes Research Unit, Faculty of Medicine , The Hebrew University , Jerusalem , Israel
| | - B Daniel
- b Institute for Drug Research, Section of Pharmacology, Diabetes Research Unit, Faculty of Medicine , The Hebrew University , Jerusalem , Israel
| | - A Sansone
- c ISOF, BioFreeRadicals Group, Consiglio Nazionale delle Ricerche , Bologna , Italy
| | - P I Petropoulou
- d Department of Pharmacology , University of Patras Medical School , Rio , Greece
| | - S Filou
- d Department of Pharmacology , University of Patras Medical School , Rio , Greece
| | - A Spyridonidis
- e Hematology Department , University of Patras Medical School , Rio , Greece
| | - G Pani
- f Institute of General Pathology, Università Cattolica del Sacro Cuore , Roma , Italy
| | - M De Spirito
- a Institute of Physics, Università Cattolica del Sacro Cuore , Roma , Italy
| | - C Chatgilialoglu
- c ISOF, BioFreeRadicals Group, Consiglio Nazionale delle Ricerche , Bologna , Italy
| | - C Ferreri
- c ISOF, BioFreeRadicals Group, Consiglio Nazionale delle Ricerche , Bologna , Italy
| | - K E Kypreos
- d Department of Pharmacology , University of Patras Medical School , Rio , Greece
| | - S Sasson
- b Institute for Drug Research, Section of Pharmacology, Diabetes Research Unit, Faculty of Medicine , The Hebrew University , Jerusalem , Israel
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Aviner S, Cohen O, El-Ubra F, Yahalom V, Bibi H, Zangen S. [DIVERSITY IN PRODUCT SELECTION AND THRESHOLDS FOR PLATELETS TRANSFUSION IN NEONATES AND PREMATURE INFANTS]. Harefuah 2016; 155:466-469. [PMID: 28530325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Many premature and full-term newborns receive prophylactic platelet transfusions to prevent bleeding, particularly the most prevalent one, i.e, intracranial hemorrhages. However, the platelet count threshold above which bleeding is prevented and the efficacy of platelet transfusion in thrombocytopenic neonates, have yet to be established. Therefore, inter-Neonatal Intensive Care Units (NICU) variations in treatment indications and practices are expected. Considerable inter-NICU variations will emphasize the need for guidelines on platelet transfusions to neonates and premature infants. AIMS To examine platelet products selection and indications for transfusion among neonatologists in Israel. Research and Methods: Electronic questionnaires addressing the choice of platelet products and the platelet count threshold for transfusion in various clinical settings were sent to 25 neonatal units. RESULTS All 25 neonatal units responded (100% response rate). There was considerable variation in product selection among the different neonatal units. Up to 24% of the participating units reported selecting nontraditional products. Variation was also found in thresholds for platelet transfusion - several units used high thresholds while others used low ones. Traditional guidelines were followed in up to 64% of cases in selected clinical scenarios. CONCLUSIONS There is considerable variation in both platelet product selection and platelet count thresholds for transfusion among the different neonatal units. DISCUSSION A low threshold for platelet transfusion increases the risk for bleeding, whereas a high threshold increases the prevalence of complications from transfusion of blood products. Adherence to guidelines may prevent both such sequelae. Summary: Such variation in platelet transfusion among neonatologists emphasizes the need for an accepted policy. We recommend setting up a committee of neonatologists, pediatric hematologists and blood service experts which aims to establish an appropriate policy regarding the prevention of platelet transfusion sequelae in newborns.
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Affiliation(s)
- Shraga Aviner
- The Department of Pediatrics, The Barzilai University Medical Center, Ashkelon
- The Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva
| | - Ornit Cohen
- Research
- Development Authority, the Barzilai University Medical Center, Ashkelon
| | - Faid El-Ubra
- The Department of Pediatrics, The Barzilai University Medical Center, Ashkelon
| | - Vered Yahalom
- Magen David Adom - National Blood Services, Tel Hashomer, Ramat Gan
| | - Haim Bibi
- The Department of Pediatrics, The Barzilai University Medical Center, Ashkelon
- The Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva
| | - Shmuel Zangen
- The Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva
- Neonatal Intensive Care Department, The Barzilai University Medical
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Kogan J, Rodnitsky A, Cohen O, Turkot S, Tziba Y, Golzman B. [TREATMENT OF MECHANICALLY VENTILATED PATIENTS IN AN INTERNAL MEDICINE DEPARTMENT - OVERVIEW 2013]. Harefuah 2016; 155:482-484. [PMID: 28530332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Over recent years the number of mechanically ventilated patients in internal medicine departments has grown. These patients are elderly, mostly disabled and suffer from many chronic illnesses. Most of them require prolonged mechanical ventilation. OBJECTIVES The study aimed to evaluate the population of mechanically ventilated patients in an internal department, the treatment and outcomes, particularly the morbidity in hospitalization and to identify the prognostic causes of death. METHODS A retrospective study was conducted to check the medical records of ventilated patients between the years 2012- 2013 in internal medicine departments including demographic information, chronic illnesses, cause of hospitalization and ventilation, complications and results of treatment. RESULTS The study includes 97 patients over the age of 60, 50% of them disabled, average Apache score was 29.9; 65% of the patients required ventilation for over 3 days and 35% for over 10 days; 71% of the patients died. The most common causes of death were pneumonia, sepsis, cerebrovascular accident, cardiac event, worsening of heart failure, worsening of chronic obstructive pulmonary disease or a combination of these. The patients who died displayed an Apache score significantly higher at admittance to the hospital. Significant risk factors for mortality included chronic diabetes, sepsis, pneumonia and renal failure. CONCLUSIONS The results raise the question of whether to increase the number of beds for internal intensive care. A discussion is required among medical personnel and laymen to define a group of patients who should not deteriorate to mechanical ventilation or any other invasive procedures.
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Affiliation(s)
- Jacov Kogan
- Department of Internal Medicine A, Barzilai Medical Center, Ashkelon, Ben Gurion University of the Negev
| | - Alex Rodnitsky
- Department of Internal Medicine A, Barzilai Medical Center, Ashkelon, Ben Gurion University of the Negev
| | - Ornit Cohen
- Department of Research and Development Authority, Barzilai Medical Center, Ashkelon, Ben Gurion University of the Negev
| | - Svetlana Turkot
- Department of Internal Medicine A, Barzilai Medical Center, Ashkelon, Ben Gurion University of the Negev
| | - Yevgenia Tziba
- Department of Internal Medicine A, Barzilai Medical Center, Ashkelon, Ben Gurion University of the Negev
| | - Boris Golzman
- Department of Internal Medicine A, Barzilai Medical Center, Ashkelon, Ben Gurion University of the Negev
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Leibowitz R, Aflalo S, Cohen O, Lustig A. [THE SHERLOCK SYSTEM - CLINICAL AND LOGISTIC PHARMACEUTICAL SERVICES]. Harefuah 2016; 155:478-481. [PMID: 28530330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The drug inventory in the hospital consumes a large part of the hospital's budget. Classic drug management is based on weekly visits of the pharmacist in the departments, writing an order and dispensing it. This method is wasteful in terms of sending a bulk of drugs that will not necessarily be utilized, and it is also inefficient in terms of human resources. The unit-dose method, which is more advanced, is based on filling out individual prescriptions for each of the inpatients in the department. This minimizes the potential of making an error on administration of the drug to the patient, while reducing the shelf-inventory in the department. A new method has been initiated at Barzilai Medical Center, starting January 2013, based on the implantation of the NAMER computerized clinical record system. This method, called SHERLOCK, which transforms the physician orders into logistic information for the pharmacist, holds all the unit-dose method advantages without the heavy costs. The system is an innovative development of the pharmacy staff in cooperation with the computer department. OBJECTIVES To design a computerized system to make drug inventory management more efficient. Methods: We started using the SHERLOCK system in the two computerized internal departments. RESULTS The data for 9 months was collected during January- September 2013 and was compared to data for the same period in 2012. This showed a significant reduction in the cost of drug distribution (p<0.05). This reduction projects an almost 20% decrease in the yearly budget at the research department. In the control departments, no significant reduction has been demonstrated. CONCLUSIONS In light of these results, it is visible that the SHERLOCK system is an efficient tool to improve drug inventory management and medication safety.
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Affiliation(s)
| | | | - Ornit Cohen
- Research and Development Authority, Barzilai University Medical Center
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Melnik I, Dukhno O, Cohen O, Goldstein D, Yoffe B. [SINGLE-INCISION TECHNIQUE FOR RIGHT HEMICOLECTOMY]. Harefuah 2016; 155:475-477. [PMID: 28530329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIMS The single incision laparoscopic technique is an emerging modality. The aim of our study was to compare the intra-operative and short term post-operative outcomes of single incision versus multi-incision laparoscopy for right hemicolectomy. METHODS We retrospectively reviewed the charts of all patients who underwent right hemicolectomy from October 2010 till December 2012. RESULTS Thirty six patients underwent laparoscopic right hemicolectomy, of which, twenty five were performed with the traditional multi-incision technique and eleven were conducted with a single incision. From the parameters that were evaluated, we found that in the single incision technique there was a statistical trend [p=0.08] of better oncological results with a higher mean lymph node extraction. In addition, there was a statistically significant [p=0.05] advantage of decreased length of hospitalization. CONCLUSIONS The single incision technique is feasible and safe for right hemicolectomy. Given our findings, we believe that it can be an effective alternative to the traditional multi-port technique.
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Affiliation(s)
- Idit Melnik
- Department of General and Vascular Surgery, Barzilai University Medical Center, Ashkelon, Israel
| | - Oleg Dukhno
- Department of General and Vascular Surgery, Barzilai University Medical Center, Ashkelon, Israel
| | - Ornit Cohen
- Department of Clinical Research, Barzilai University Medical Center, Ashkelon, Israel
| | - Dimitry Goldstein
- Department of General and Vascular Surgery, Barzilai University Medical Center, Ashkelon, Israel
| | - Boris Yoffe
- Department of General and Vascular Surgery, Barzilai University Medical Center, Ashkelon, Israel
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Lakstein D, Bachar I, Debi R, Lubovsky O, Cohen O, Tan Z, Atoun E. Radiographic templating of total hip arthroplasty for femoral neck fractures. Int Orthop 2016; 41:831-836. [PMID: 27271723 DOI: 10.1007/s00264-016-3235-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the use of pre-operative digital templating to minimize complications including limb length discrepancy (LLD), intraoperative fractures and early dislocations in patients with intracapsular femoral neck fractures. METHODS We retrospectively compared 23 patients undergoing total hip arthroplasty (THA) for intracapsular femoral fractures with pre-operative digital templating and 48 patients without templating. RESULTS The mean post-operative LLD was significantly lower in patients who had pre-operative templating than in the control group (6.7 vs. 11.5 mm, p = 0.023). Only three patients (13 %) with templating had LLD greater than 1.5 cm, compared to the 15 patients (31 %) without templating (p = 0.17). In eight cases the final femoral stem size matched the templated size, while 19 patients were within two size increments. Complications included one dislocation and one intra-operative fracture in the control group. CONCLUSION The present study demonstrated that careful pre-operative planning may reduce LLD in patients undergoing THA due to intracapsular hip fractures.
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Affiliation(s)
- Dror Lakstein
- Faculty of Medicine, Tel Aviv University, Wolfson Medical Centre, Holon, Israel
| | - Ira Bachar
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ronen Debi
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Omri Lubovsky
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ornit Cohen
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Zachary Tan
- Faculty of Medicine, Tel Aviv University, Wolfson Medical Centre, Holon, Israel
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel.
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Cohen O, Agabria Z, Lysyy L, Ianovitsky Y, Nguyen X, Fung M, Lee S, Wainstein J. Adaptability of structured forms for CSII initiation in patients with type 2 diabetes the Getting2Goal(SM) concept. J Endocrinol Invest 2016; 39:627-33. [PMID: 26746672 PMCID: PMC4869731 DOI: 10.1007/s40618-015-0407-3] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/29/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND The goal is to assess the usability and satisfaction of implementing the Getting2Goal(SM) protocol by physicians transitioning patients with type 2 diabetes (T2DM) from multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII). METHODS T2DM patients from three diabetes clinics were switched from MDI to CSII. Physicians used the Getting2Goal type 2 pumping protocol to prescribe and manage insulin pump therapy for T2DM. Surveys were conducted in which the physicians rated their feedback related to acceptability of the Getting2Goal on a 5-point Likert scale. RESULTS 17 patients with T2DM were switched from MDI to CSII treatment. Mean (±standard deviation) age was 61.2 ± 7.7 (46-77) years, weight was 91.4 ± 21 (66-147) kg, BMI was 31.9 ± 7.6, A1C was 9.2 ± 1.4 % (7.2-12.3) and TDD on MDI was 109.1 ± 53.1 units. Surveys completed by physicians indicated Getting2Goal type 2 pumping protocol to be more efficient, time saving, and structured compared to their current processes. In addition, the primarily prescribed TDD on pump was 98.1 ± 50.0 units and the TDD at first download was 81.4 ± 36.4 units, representing a 25.4 % reduction in TDD At first download. The percentage of all blood glucose readings below 70 mg/dL was also very low. CONCLUSIONS The data indicate Getting2Goal materials as a standard approach that is simple and efficient to initiate pump therapy for T2DM. At the same time, it is safe and a useful tool for physicians that are starting to prescribe pump therapy for T2DM.
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Affiliation(s)
- O Cohen
- Sackler School of Medicine, Ch. Sheba Medical Center, Institute of Endocrinology, Tel Hashomer, Tel Aviv University, 52621, Tel Aviv, Israel.
| | - Z Agabria
- Cllalit Health Services, Tel Aviv, Israel
| | - L Lysyy
- Diabetes Clinic, Maccabi Health Service, Rehovot, Israel
- Endocrinology and Metabolism Clinic, Kaplan Medical Center, Rehovot, Israel
| | - Y Ianovitsky
- Diabetes Clinic, Maccabi Health Service, Ashkelon, Israel
| | - X Nguyen
- Medtronic, Inc., Northridge, CA, USA
| | - M Fung
- Medtronic, Inc., Northridge, CA, USA
| | - S Lee
- Medtronic, Inc., Northridge, CA, USA
| | - J Wainstein
- Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
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Aronson R, Reznik Y, Conget I, Castañeda JA, Runzis S, Lee SW, Cohen O. Sustained efficacy of insulin pump therapy compared with multiple daily injections in type 2 diabetes: 12-month data from the OpT2mise randomized trial. Diabetes Obes Metab 2016; 18:500-7. [PMID: 26854123 PMCID: PMC5071718 DOI: 10.1111/dom.12642] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/29/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
AIMS To compare insulin pump therapy and multiple daily injections (MDI) in patients with type 2 diabetes receiving basal and prandial insulin analogues. METHODS After a 2-month dose-optimization period, 331 patients with glycated haemoglobin (HbA1c) levels ≥8.0% and ≤12% were randomized to pump therapy or continued MDI for 6 months [randomization phase (RP)]. The MDI group was subsequently switched to pump therapy during a 6-month continuation phase (CP). The primary endpoint was the between-group difference in change in mean HbA1c from baseline to the end of the RP. RESULTS The mean HbA1c at baseline was 9% in both groups. At the end of the RP, the reduction in HbA1c was significantly greater with pump therapy than with MDI (-1.1 ± 1.2% vs -0.4 ± 1.1%; p < 0.001). The pump therapy group maintained this improvement to 12 months while the MDI group, which was switched to pump therapy, showed a 0.8% reduction: the final HbA1c level was identical in both arms. In the RP, total daily insulin dose (TDD) was 20.4% lower with pump therapy than with MDI and remained stable in the CP. The MDI-pump group showed a 19% decline in TDD, such that by 12 months TDD was equivalent in both groups. There were no differences in weight gain or ketoacidosis between groups. In the CP, one patient in each group experienced severe hypoglycaemia. CONCLUSIONS Pump therapy has a sustained durable effect on glycaemic control in uncontrolled type 2 diabetes.
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Affiliation(s)
- R. Aronson
- LMC Diabetes and EndocrinologyTorontoONCanada
| | - Y. Reznik
- Department of EndocrinologyUniversity of Caen Côte de Nacre Regional Hospital CenterCaenFrance
| | - I. Conget
- Diabetes Unit, Endocrinology and Nutrition DepartmentUniversity Hospital ClinicBarcelonaSpain
| | | | - S. Runzis
- Medtronic International Trading SàrlTolochenazSwitzerland
| | | | - O. Cohen
- Institute of EndocrinologyChaim Sheba Medical CenterTel HashomerIsrael
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Schütz-Fuhrmann I, Reznik Y, Aronson R, Cohen O, Conget I, Prager R, Liabat S, Runzis S, de Portu S, Castañeda J. Faktoren, die den Erfolg der Insulindosis-Adaptierung bei Patienten mit Diabetes mellitus Typ 2 beeinflussen: eine Analyse aus der OpT2mise Studie. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580878] [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: 10/21/2022]
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Levy-Shraga Y, Elisha N, Ben-Ami M, Boyko V, Lerner-Geva L, Ziv T, Konvalina N, Cohen O, Pinhas-Hamiel O. Glycemic control and clinic attendance of emerging adults with type 1 diabetes at a transition care clinic. Acta Diabetol 2016; 53:27-33. [PMID: 25794880 DOI: 10.1007/s00592-015-0734-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 03/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Emerging adulthood is a challenging period for diabetes management. Our aim was to determine whether a dedicated transition clinic for emerging adults with type 1 diabetes can improve glycemic control and visit attendance. METHODS An observational study of 53 emerging adults (30 males) treated during 2010-2014 in a newly established transition clinic. The clinic was operated jointly by pediatric and adult endocrinologists and included a transition coordinator. Data collected included the source of referral, HbA1c levels, frequency of visit attendance, and acute complications. For 27 patients who had attended the pediatric clinic at the same medical center, data from up to 2 years preceding the transition were also collected. Patients filled the Diabetes Quality of Life-Youth questionnaire at the transition and 1 year later. RESULTS Mean ± SD age at the transfer to the transition clinic was 22.1 ± 2.7 years; mean disease duration was 8.4 ± 5.0 years. Follow-up duration at the transition clinic was 1.2 ± 1.1 years. Mean HbA1c levels decreased from 67 mmol/mol (95 % CI 63-72) [8.3 % (95 % CI 7.9-8.7)] at transfer to 57 mmol/mol (95 % CI 52-63) [7.4 % (95 % CI 6.9-7.9)] after 1 year (p < 0.001). Thirty-six patients (68 %) attended three or more visits during their first year in the transition clinic. The impact of diabetes on quality of life, disease-related worries, and life satisfaction did not change significantly during 1-year attendance in the transition clinic. CONCLUSIONS A dedicated transition clinic for emerging adults, with tailored support according to the developmental needs of emerging adulthood, showed improved glycemic control and visit attendance.
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Affiliation(s)
- Y Levy-Shraga
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - N Elisha
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - M Ben-Ami
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - V Boyko
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - L Lerner-Geva
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - T Ziv
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - N Konvalina
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - O Cohen
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - O Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Debi R, Lubovsky O, Cohen O, Bachar I, M Debbi E, Atoun E. Anteversion of the Acetabular Cup Determined by
Digital Radiographic Software as Compared to CT-Based
Measurement. ACTA ACUST UNITED AC 2016. [DOI: 10.17554/j.issn.2311-5106.2016.03.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Farkash AL, Katz A, Cohen O, Fishman E, Yosefy C, Khalameizer V. Safety and Feasibility of Contrast Injection During Pulmonary Vein Isolation with the nMARQ™ Multi-Electrode Catheter. J Atr Fibrillation 2015; 8:1324. [PMID: 27957231 DOI: 10.4022/jafib.1324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/12/2015] [Accepted: 12/14/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) using the irrigated multi-electrode ablation system (nMARQ™) remains challenging in complex atrial anatomy cases and when CARTOMERGE™ technology is not available, due to absence of a leading guide-wire. OBJECTIVES Our objective was to assess feasibility and safety of PVI using nMARQ™ catheter with intra-procedural contrast injections through the deflectable sheath compared to nMARQ™ alone. METHODS This is a prospective non-randomized observational study of 78 consecutive patients who underwent PVI only with nMARQ™. The first group (n=37, 64±10.5 years, 62% male, 13.5% persistent AF) underwent the procedure with the guidance of signal mapping, fluoroscopy, and electro-anatomical mapping (EAM) alone. Since 12/2013 an automatic closed-loop contrast media injector was added to improve catheter location (n=41, 62.5±11 years, 71% male, 34% persistent AF). RESULTS Total procedure time was 78±19 and 85.5±18.5 minutes, and mean fluoroscopy time was 30±9 and 29.5±8.7 minutes for the first and second groups, respectively (NS); acute success rate was 97% and 97.5%, with a mean of 14.7±5 and 17.6±5.4 RF applications, respectively (p=0.02); and mean total burning time of 10.3±3.6 and 12±4 minutes, respectively (p=0.08). Mean contrast used was 60±18 mL versus 203±65 mL, with no effect on renal function or major complications. One year freedom from AF was 77% and 83%, respectively (p=0.5). CONCLUSIONS Addition of contrast injections to standard nMARQ™ procedure is feasible and safe. It has no benefit in routine use but further studies may confirm its potential added value to EAM in catheter localization by newly trained operators and in selective cases of large/common PV anatomy.
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Affiliation(s)
- Avishag Laish Farkash
- Cardiology Department, Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amos Katz
- Cardiology Department, Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ornit Cohen
- Cardiology Department, Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Evgeny Fishman
- Cardiology Department, Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Chaim Yosefy
- Cardiology Department, Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vladimir Khalameizer
- Cardiology Department, Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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de Breij A, Riool M, Kwakman PHS, de Boer L, Cordfunke RA, Drijfhout JW, Cohen O, Emanuel N, Zaat SAJ, Nibbering PH, Moriarty TF. Prevention of Staphylococcus aureus biomaterial-associated infections using a polymer-lipid coating containing the antimicrobial peptide OP-145. J Control Release 2015; 222:1-8. [PMID: 26658071 DOI: 10.1016/j.jconrel.2015.12.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
The scarcity of current antibiotic-based strategies to prevent biomaterial-associated infections (BAI) and their risk of resistance development prompted us to develop a novel antimicrobial implant-coating to prevent Staphylococcus aureus-induced BAI. We incorporated the antimicrobial peptide OP-145 into a Polymer-Lipid Encapsulation MatriX (PLEX)-coating to obtain high peptide levels for prolonged periods at the implant-tissue interphase. We first confirmed that OP-145 was highly effective in killing S. aureus and inhibiting biofilm formation in vitro. OP-145 injected along S. aureus-inoculated implants in mice significantly reduced the number of culture-positive implants. OP-145 was released from the PLEX coating in a controlled zero-order kinetic rate after an initial 55%-burst release and displayed bactericidal activity in vitro. In a rabbit intramedullary nail-related infection model, 67% of rabbits with PLEX-OP-145-coated nails had culture-negative nails after 28days compared to 29% of rabbits with uncoated nails. In rabbits with PLEX-OP-145-coated nails, bone and soft tissue samples were culture-negative in 67% and 80%, respectively, whereas all bone samples and 71% of the soft tissue samples of rabbits with uncoated nails were infected. Together, PLEX-OP-145 coatings, of which both compounds have already been found safe in man, can prevent implant colonization and S. aureus-induced BAIs.
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Affiliation(s)
- A de Breij
- Dept. of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, P.O. Box 9600, RC Leiden, The Netherlands.
| | - M Riool
- Dept. of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - P H S Kwakman
- Dept. of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - L de Boer
- Dept. of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - R A Cordfunke
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, P.O. Box 9600 RC Leiden, the Netherlands
| | - J W Drijfhout
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, P.O. Box 9600 RC Leiden, the Netherlands
| | - O Cohen
- PolyPid Ltd., 18 Hasivim, St. Petach-Tikva 4959376, Israel
| | - N Emanuel
- PolyPid Ltd., 18 Hasivim, St. Petach-Tikva 4959376, Israel
| | - S A J Zaat
- Dept. of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - P H Nibbering
- Dept. of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, P.O. Box 9600, RC Leiden, The Netherlands
| | - T F Moriarty
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8 Davos Platz, CH7270 Davos, Switzerland
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Battelino T, Liabat S, Veeze HJ, Castañeda J, Arrieta A, Cohen O. Routine use of continuous glucose monitoring in 10 501 people with diabetes mellitus. Diabet Med 2015; 32:1568-74. [PMID: 26042926 PMCID: PMC4744771 DOI: 10.1111/dme.12825] [Citation(s) in RCA: 44] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 01/04/2023]
Abstract
AIMS To analyse blood glucose control according to continuous glucose monitoring use in data from the CareLink database, and to identify factors associated with continuation of sensor use during sensor-augmented pump therapy. METHODS The analysis used data from 10 501 people with Type 1 and 2 diabetes mellitus, of whom 7916 (61.7%) had used glucose sensors for ≥ 15 days during any 6-month period over a 2-year observation period. Data were analysed according to the extent of sensor use ( < 25%, 25-49%, 50-74% and ≥ 75% of the time). Time to discontinuation of sensor use was also analysed in new users of glucose sensors. RESULTS Compared with patients in the lowest sensor usage group and non-users, the highest glucose sensor usage group had significantly (P < 0.0001) lower mean blood glucose and blood glucose sd, were more likely to achieve a mean blood glucose concentration < 8.6 mmol/l, (odds ratio 1.5, 95% CI 1.3-1.7; P < 0.0001), and had 50% fewer hypoglycaemic (blood glucose concentration < 2.8 mmol/l) episodes. Among new users, sensor use during the first month of therapy was an important predictor of subsequent discontinuation. Lack of full reimbursement was also significantly associated with early discontinuation, whereas measures of glycaemic control were predictive of discontinuation during long-term treatment. CONCLUSIONS The use of continuous glucose monitoring was significantly associated with reductions in hypoglycaemia and improved metabolic control during insulin pump therapy. Sensor use during the first month was strongly associated with long-term adherence; patient education and training may be helpful in achieving this.
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MESH Headings
- Blood Glucose/analysis
- Canada
- Cohort Studies
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/economics
- Drug Resistance
- Europe
- Health Information Exchange
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/chemically induced
- Hypoglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Insulin/administration & dosage
- Insulin/adverse effects
- Insulin/therapeutic use
- Insulin Infusion Systems/adverse effects
- Insurance, Health, Reimbursement
- Israel
- Monitoring, Ambulatory/economics
- Patient Compliance
- Practice Patterns, Physicians'
- Time Factors
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Affiliation(s)
- T Battelino
- University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - S Liabat
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - H J Veeze
- Diabeter, Centre for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - J Castañeda
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - A Arrieta
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - O Cohen
- Chaim Sheba Medical Centre, Ramat Gan, Israel
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