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Shah H, Parisi R, Everdell E, Feustel P, Davis L. The effect of COVID-19 on early melanoma detection. Melanoma Res 2024; 34:283-284. [PMID: 38661481 DOI: 10.1097/cmr.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | | | | | | | - Lindy Davis
- Department of Surgery, Albany Medical Center, Albany, New York, USA
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2
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Kirkland JM, Edgar EL, Patel I, Feustel P, Belin S, Kopec AM. Synaptic pruning during adolescence shapes adult social behavior in both males and females. Dev Psychobiol 2024; 66:e22473. [PMID: 38433422 DOI: 10.1002/dev.22473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Evolutionarily conserved, peer-directed social behaviors are essential to participate in many aspects of human society. These behaviors directly impact psychological, physiological, and behavioral maturation. Adolescence is an evolutionarily conserved period during which reward-related behaviors, including social behaviors, develop via developmental plasticity in the mesolimbic dopaminergic "reward" circuitry of the brain. The nucleus accumbens (NAc) is an intermediate reward relay center that develops during adolescence and mediates both social behaviors and dopaminergic signaling. In several developing brain regions, synaptic pruning mediated by microglia, the resident immune cells of the brain, is important for normal behavioral development. We previously demonstrated that during adolescence, in rats, microglial synaptic pruning shapes the development of NAc and social play behavior in males and females. In this report, we hypothesize that interrupting microglial pruning in NAc during adolescence will have persistent effects on male and female social behavior in adulthood. We found that inhibiting microglial pruning in the NAc during adolescence had different effects on social behavior in males and females. In males, inhibiting pruning increased familiar exploration and increased nonsocial contact. In females, inhibiting pruning did not change familiar exploration behavior but increased active social interaction. This leads us to infer that naturally occurring NAc pruning serves to reduce social behaviors toward a familiar conspecific in both males and females.
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Affiliation(s)
- Julia M Kirkland
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Erin L Edgar
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Ishan Patel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Sophie Belin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Ashley M Kopec
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
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3
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Parisi R, Shah H, Everdell E, Feustel P, Davis L. First-time office visit for suspicious skin lesion evaluation as a predictor of high-risk melanoma. Melanoma Res 2023; 33:555-556. [PMID: 37890184 DOI: 10.1097/cmr.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
| | | | | | | | - Lindy Davis
- Department of Surgery, Albany Medical Center, Albany, New York, USA
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4
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Ahsan L, Zheng WQ, Kaur G, Kadakuntla A, Remaley AT, Sampson M, Feustel P, Nappi A, Mookherjee S, Lyubarova R. Association of Lipoprotein Subfractions With Presence and Severity of Coronary Artery Disease in Patients Referred for Coronary Angiography. Am J Cardiol 2023; 203:212-218. [PMID: 37499601 DOI: 10.1016/j.amjcard.2023.06.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
Lipoprotein subfractions (LS) can be used for better risk stratification in subjects deemed not at high risk for coronary artery disease (CAD). In this study, we evaluated the correlation between LS with CAD presence and severity. This is a prospective case-control study of 157 patients referred for coronary angiography who were not on lipid-lowering therapy and had LS measured by nuclear magnetic resonance spectroscopy. Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) scores were calculated to estimate CAD severity. Univariate and multivariable regression analysis was performed to determine correlation of LS with CAD presence and severity and acute coronary syndrome (ACS). There was significant association of certain LS (positive for total low-density lipoprotein particle [LDL-P], small LDL-P and apolipoprotein B, negative for large high-density lipoprotein particle [HDL-P] and apolipoprotein A1 [ApoA1]) with the presence of obstructive CAD and CAD severity. Small LDL-P and HDL-P were still predictive for obstructive CAD after adjusting for traditional risk factors, 10-year atherosclerotic cardiovascular disease risk score and in those with low-density lipoprotein cholesterol <100 mg/100 ml. Total LDL-P and ApoA1 were predictive of CAD severity on multivariable analysis. Higher small LDL-P and lower large HDL-P were associated with ACS presence, although only large HDL-P had a significant inverse correlation with ACS on adjusted analysis (odds ratio 0.74 95% confidence interval 0.58, 0.95) In conclusion, in our cohort of patients referred for coronary angiography, total LDL-P, small LDL-P, and apolipoprotein B had significant direct correlation, and large HDL-P and ApoA1 had significant inverse correlation with obstructive CAD and CAD severity.
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Affiliation(s)
- Lusana Ahsan
- Department of Medicine, Albany Medical College, Albany, New York
| | - Wen Qian Zheng
- Department of Medicine, Albany Medical College, Albany, New York
| | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, National Heart, Lung and Blood Institute, National Institute of Health, Bethesda, Maryland
| | - Maureen Sampson
- Department Laboratory Medicine, Clinical Center, National Institute of Health, Bethesda, Maryland
| | - Paul Feustel
- Department of Medicine, Albany Medical College, Albany, New York
| | - Anthony Nappi
- Department of Medicine, Albany Medical College, Albany, New York
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5
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Leizer JM, Ibrahim AM, Foulke LA, Tauber KA, Feustel P, Zelig CM. Using Middle Cerebral Artery Doppler Ultrasound to Predict Clinical Chorioamnionitis After Preterm Prelabor Rupture of Membranes. Cureus 2023; 15:e41508. [PMID: 37551247 PMCID: PMC10404386 DOI: 10.7759/cureus.41508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND In neonates, blood flow to the brain as measured by peak systolic velocity (PSV) in the middle cerebral artery (MCA) is altered in pregnancies affected by chorioamnionitis. OBJECTIVE We aim to determine whether PSV and other measures of flow in the MCA in the fetus are altered prior to the development of clinical chorioamnionitis following preterm prelabor rupture of membranes (PPROM). METHODS This was a prospective observational study. Fifty patients from one institution were recruited after being diagnosed with PPROM between 23 weeks zero days and 33 weeks six days gestation. We performed measurements of the PSV in the fetal MCA on a weekly basis following PPROM and used the value taken closest to the time of delivery for our statistical analysis. The primary outcome assessed was clinical chorioamnionitis, and the exposure of interest was MCA PSV. Additional independent variables of interest were other Doppler measures of the MCA. Secondary outcomes included histological chorioamnionitis and other measures of neonatal health, including sepsis, days in the neonatal intensive care unit (NICU), and death. RESULTS Of the 50 patients recruited to our study, eight (16%) developed clinical chorioamnionitis, similar to previously reported values in the general population. The PSV in the MCA was not significantly associated with the development of clinical chorioamnionitis. However, an elevated MCA pulsatility index (PI), a measure of resistance to flow, was associated with a higher probability of developing clinical chorioamnionitis. CONCLUSION There does not appear to be a difference in the PSV of the MCA of fetuses in pregnancies following PPROM with impending chorioamnionitis. However, elevated PI in the MCA could be a marker of impending chorioamnionitis in PPROM. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Julie M Leizer
- Obstetrics and Gynecology, Robert Wood Johnson (RWJ) Barnabas Health, Eatontown, USA
| | - Ammoura M Ibrahim
- Pathology, University of Miami Miller School of Medicine, Miami, USA
| | | | | | - Paul Feustel
- Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, USA
| | - Craig M Zelig
- Obstetrics and Gynecology, Albany Medical Center, Albany, USA
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Welliver C, Zipkin J, Lin B, Patel D, Feustel P, McCullough A. Factors affecting post-vasectomy semen analysis compliance in home- and lab-based testing. Can Urol Assoc J 2023:cuaj.8118. [PMID: 37068146 PMCID: PMC10382220 DOI: 10.5489/cuaj.8118] [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: 04/19/2023]
Abstract
INTRODUCTION We used a home-based (HB) post-vasectomy semen analysis (PVSA) between 2014 and 2017, but we have since reverted to local lab-based (LB) testing. In this study, we compared PVSA compliance rates in HB and LB test settings and describe factors that may influence completion rates. METHODS We retrospectively identified patients who underwent vasectomy at our institution. Surgeons X and Y performed vasectomies from 2014-2017 using a HB immunochromatographic PVSA kit. From 2017-2020 surgeon X used a local LB PVSA. We collected data on PVSA completion status and patient demographics to perform two analyses. HB testing was examined by assessing all patients who had a vasectomy from 2014-2017. Another compared HB and LB testing by looking at surgeon X vasectomies from 2014-2017 and 2017-2020. RESULTS We identified 285 patients who underwent vasectomy from 2014-2017 and were assessed with HB testing. Compliance with PVSA was 35% with HB PVSA. Age at vasectomy, number of children, and surgeon influenced PVSA completion in the 2014-2017 cohort. Surgeon X PVSA completion was 29% for the HB (n=136) testing cohort and 46% for the LB (n=201) cohort (odds ratio 0.47, 95% confidence interval 0.29-0.74). Again, more children decreased PVSA completion. CONCLUSIONS Compliance with PVSA testing was inadequate in both test settings, although it was significantly higher in local LB setting. Based on these findings, the convenience of HB testing appears to decrease compliance with PVSA, although surgeon factors may be influential. These findings may help surgeons identify factors that improve PVSA compliance rates.
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Affiliation(s)
- Charles Welliver
- Department of Urology, Albany Medical College, Albany, NY, United States
- Albany Stratton Veterans Affairs Medical Center, Albany, NY, United States
| | - Jacob Zipkin
- Department of Urology, Albany Medical College, Albany, NY, United States
| | - Brenda Lin
- Department of Urology, Albany Medical College, Albany, NY, United States
| | - Dhruv Patel
- Department of Urology, Albany Medical College, Albany, NY, United States
| | - Paul Feustel
- Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY, United States
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Shah H, Feustel P, Davis L. Adherence with surveillance schedule in patients with invasive melanoma. Surg Oncol 2023; 48:101943. [PMID: 37054530 DOI: 10.1016/j.suronc.2023.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Seven percent of patients develop melanoma recurrence after successful treatment, and 4-8% develop a second primary melanoma. This study aimed to assess how providing Survivorship Care Plans (SCPs) to patients may improve adherence to surveillance visits. METHODS All patients treated for invasive melanoma at our institution between 8/1/2018-2/29/2020 were included in this retrospective chart review. SCPs were delivered in-person to patients and sent to primary care providers and dermatologists. Logistic regression was performed to assess influences on adherence. RESULTS Of 142 patients, 73 (51.4%) received SCP regarding their follow-up care. Reception of SCP (p = 0.044) and shorter distance from clinic (p = 0.018) significantly improved rates of adherence. Seven patients developed melanoma recurrences, five were physician-detected. Three patients had primary site recurrence, six had lymph node recurrences, and three had distant recurrences. There were 5 second primaries, all physician-detected. CONCLUSION Our study is the first to investigate the impact of SCPs on patient adherence in melanoma survivors and the first to reveal a positive correlation between SCPs and adherence in any type of cancer. Melanoma survivors require close clinical follow-up, as demonstrated by our study finding that even with SCPs, most recurrences and all new primary melanomas were physician-detected.
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Affiliation(s)
- Hemali Shah
- Albany Medical College, 43 New Scotland Avenue, Albany, NY, 12208, USA
| | - Paul Feustel
- Albany Medical College, 43 New Scotland Avenue, Albany, NY, 12208, USA
| | - Lindy Davis
- Albany Medical College, Department of Surgery, 50 New Scotland Avenue, Albany, NY, 12208, USA.
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Mian BM, Singh Z, Carnes K, Lorenz L, Feustel P, Kaufman RP, Avulova S, Bernstein A, Cangero T, Fisher HAG. Implementation and Assessment of No Opioid Prescription Strategy at Discharge After Major Urologic Cancer Surgery. JAMA Surg 2023; 158:378-385. [PMID: 36753170 PMCID: PMC9909575 DOI: 10.1001/jamasurg.2022.7652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/22/2022] [Indexed: 02/09/2023]
Abstract
Importance Postoperative opioid prescriptions are associated with delayed recovery, perioperative complications, opioid use disorder, and diversion of overprescribed opioids, which places the community at risk of opioid misuse or addiction. Objective To assess a protocol for eliminating postdischarge opioid prescriptions after major urologic cancer surgery. Design, Setting, and Participants This cohort study of the no opioid prescriptions at discharge after surgery (NOPIOIDS) protocol was conducted between May 2017 and June 2021 at a tertiary referral center. Patients undergoing open or minimally invasive radical cystectomy, radical or partial nephrectomy, and radical prostatectomy were sorted into the control group (usual opioids), the lead-in group (reduced opioids), and the NOPIOIDS group (no opioid prescriptions). Interventions The NOPIOIDS group received a preadmission educational handout, postdischarge instructions for using nonopioid analgesics, and no routine opioid prescriptions. The lead-in group received a postdischarge instruction sheet and reduced opioid prescriptions at prescribers' discretion. The control group received opioid prescriptions at prescribers' discretion. Main Outcomes and Measures Primary outcome measures included rate and dose of opioid prescriptions at discharge and for 30 days postdischarge. Additional outcome measures included patient-reported pain and satisfaction level, unplanned health care utilization, and postoperative complications. Results Of 647 opioid-naive patients (mean [SD] age, 63.6 [10.0] years; 478 [73.9%] male; 586 [90.6%] White), the rate of opioid prescriptions at discharge for the control, the lead-in, and the NOPIOIDS groups was 80.9% (157 of 194), 57.9% (55 of 95), and 2.2% (8 of 358) (Kruskal-Wallis test of medians: P < .001), and the overall median (IQR) tablets prescribed was 14 (10-20), 4 (0-5.3), and 0 (0-0) per patient in the control, lead-in, and NOPIOIDS groups, respectively (Kruskal-Wallis test of medians: P < .001). In the NOPIOIDS group, median and mean opioid dose was 0 tablets for all procedure types, with the exception of kidney procedures (mean [SD], 0.5 [1.7] tablets). Patient-reported pain surveys were received from 358 patients (72.6%) in the NOPIOIDS group, demonstrating low pain scores (mean [SD], 2.5 [0.86]) and high satisfaction scores (mean [SD], 86.6 [3.8]). There was no increase in postoperative complications in the group with no opioid prescriptions. Conclusions and Relevance This perioperative protocol, with emphasis on nonopioid alternatives and patient instructions, may be safe and effective in nearly eliminating the need for opioid prescriptions after major abdominopelvic cancer surgery without adversely affecting pain control, complications, or recovery.
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Affiliation(s)
- Badar M. Mian
- Department of Urology, Albany Medical Center, Albany, New York
| | - Zorawar Singh
- Department of Urology, Albany Medical Center, Albany, New York
| | - Kevin Carnes
- Department of Urology, Albany Medical Center, Albany, New York
| | - Leanne Lorenz
- Department of Surgery, Albany Medical Center, Albany, New York
| | - Paul Feustel
- Department of Urology, Albany Medical Center, Albany, New York
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, New York
| | | | | | | | - Theodore Cangero
- Department of Information Services, Albany Medical Center, Albany, New York
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9
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Zouridis S, Sangha M, Feustel P, Richter S. Clostridium difficile Infection Rates During the Pandemic in New York Capital Area: A Single-Center Study. Cureus 2023; 15:e37576. [PMID: 37193428 PMCID: PMC10183223 DOI: 10.7759/cureus.37576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
Introduction Clostridioides difficile (C. difficile) colonizes the large intestine, rendering healthy individuals asymptomatic carriers of the disease. In certain instances, C. difficile infection (CDI) occurs. Antibiotic use remains the leading risk factor for CDI. During the coronavirus disease 2019 (COVID-19) pandemic, multiple risk and protective factors for and against CDI were identified, and as such multiple studies tried to analyze the pandemic's overall effect on CDI incidence rates, with contradictory results. Our study's aim is to further characterize the CDI incidence rates trends, but for a longer period of 22 months in the pandemic. Methods We included only adult (>18 years) patients, diagnosed with CDI during their hospitalization for the following period: January 1, 2018, to December 31, 2021. Incidence was calculated as cases per 10,000 patient days. The period identified as the COVID-19 pandemic period was the following: March 1, 2020, to December 31, 2021. All analyses were performed by an expert statistician using Minitab software (Minitab Inc., State College, Pennsylvania, United States). Results The mean CDI incidence rate per 10,000 patient-days was 6.86 +/-2.1. The 95% confidence interval for the CDI incidence rate prior to the pandemic was found at 5.67 +/-0.35 while the interval during the pandemic was calculated at 8.06 +/- 0.41 per 10,000 patient days. Those results reveal a statistically significant increase in CDI incidence rates during the COVID-19 era. Conclusion Multiple risk and protective factors for and against hospital-acquired infections (including CDI) have been identified during the unprecedented COVID-19 healthcare crisis. In the literature, there is high controversy regarding the trends of CDI incidence during the pandemic. The current study analyzed an almost two-year period into the pandemic, identifying an increase in CDI rates when compared to the pre-pandemic era.
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Affiliation(s)
| | - Maheep Sangha
- Gastroenterology and Hepatology, Albany Medical Center, Albany, USA
| | - Paul Feustel
- Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, USA
| | - Seth Richter
- Gastroenterology and Hepatology, Albany Medical Center, Albany, USA
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Marcellon R, Donovan K, Zhou H, Fiust-Klink S, Calawerts W, Patel M, Watman O, Miller D, Sorum P, Manjunath K, Stetzer R, Wales D, Mason H, Waxman M, Dacus H, Feustel P, Tadros M. Developing a Novel Interactive Colorectal Cancer Educational Session for First-Year Medical Students to Enhance Interest in Public Health. J Cancer Educ 2023; 38:127-133. [PMID: 34553335 PMCID: PMC8457545 DOI: 10.1007/s13187-021-02087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
Medical students need more exposure to and a greater understanding of their role in public health throughout their training, which may influence more of them to pursue careers in public health or change how they practice medicine in the future. A novel colorectal cancer education session was created for first year medical students to attempt to increase public health interest, improve colorectal cancer knowledge and discuss barriers to colorectal cancer screening. We constructed a novel integrated interactive peer led colorectal cancer educational session of panelists with a wide range of experiences in colorectal cancer and colorectal cancer screening. The session involved a didactic component, case presentation, and group exercises followed by assembly discussion. We surveyed first-year medical students over two consecutive years to assess their interest in public health, knowledge of colorectal cancer, and perceptions of barriers to colorectal cancer screening before and after the educational session. We also evaluated student satisfaction with the session. We compared the pre- and post-survey results to assess for changes in interest, knowledge and perceptions. 74.63% of students in 2018 and 67.7% in 2019 evaluated the session as excellent or good, with knowledge regarding colorectal cancer screening markedly increased after the educational session. Students reported knowledge and access to healthcare among the biggest patient barriers to colorectal cancer screening. Interest in public health increased by 7.5% and 5.6% in 2018 and 2019, respectively. The implementation of this interactive educational peer led exercise can increase interest in public health, improve knowledge of colorectal cancer prevention and facilitate discussions of colorectal cancer screening barriers. We hope to encourage other programs to adopt this preliminary model.
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Affiliation(s)
| | | | - Helen Zhou
- Albany Medical College, Albany, NY 12208 USA
| | | | | | - Mihir Patel
- Albany Medical College, Albany, NY 12208 USA
| | | | | | - Paul Sorum
- Department of Internal Medicine and Pediatrics, Albany Medical Center Hospital, Albany , NY 12208 USA
| | | | - Rebecca Stetzer
- Department of Family and Community Medicine, Albany Medical Center Hospital, Albany , NY 12208 USA
| | - Danielle Wales
- Department of Internal Medicine and Pediatrics, Albany Medical Center Hospital, Albany , NY 12208 USA
| | | | | | - Heather Dacus
- New York State Department of Health, Albany, NY 12204 USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208 USA
| | - Michael Tadros
- Department of Gastroenterology, Albany Medical Center Hospital, Albany, NY 12208 USA
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11
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Lende M, Feustel P, Nicasio E, Lynch TA. Does a change in cervical dilation after anesthesia impact latency after cerclage placement? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.928] [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: 01/09/2023]
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12
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Oweis J, Leamon A, Al-Tarbsheh AH, Goodspeed K, Khorolsky C, Feustel P, Naseer U, Albaba I, Parimi SA, Shkolnik B, Tiwari A, Chopra A, Torosoff M. Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients. Heart Lung 2023; 57:19-24. [PMID: 35987113 PMCID: PMC9365873 DOI: 10.1016/j.hrtlng.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The impact of the right ventricular (RV) structure and function on the in-hospital outcomes in patients with COVID-19 infection has not been rigorously investigated. OBJECTIVES The main aim of our study was to investigate in-hospital outcomes including mortality, ICU admission, mechanical ventilation, pressor support, associated with RV dilatation, and RV systolic dysfunction in COVID-19 patients without a history of pulmonary hypertension. METHODS It was a single academic tertiary center, retrospective cohort study of 997 PCR-confirmed COVID-19 patients. One hundred ninty-four of those patients did not have a history of pulmonary hypertension and underwent transthoracic echocardiography at the request of the treating physicians for clinical indications. Clinical endpoints which included mortality, ICU admission, need for mechanical ventilation or pressor support were abstracted from the electronic charts. RESULTS Patients' mean age was 68+/-16 years old and 42% of the study population were females. COPD was reported in 13% of the study population, whereas asthma was 10%, and CAD was 25%. The mean BMI was 29.8+/-9.5 kg/m2. Overall mortality was 27%, 46% in ICU patients, and 9% in the rest of the cohort. There were no significant differences in co-morbidities between expired patients and the survivors. A total of 19% of patients had evidence of RV dilatation and 17% manifested decreased RV systolic function. RV dilatation or decreased RV systolic function were noted in 24% of the total study population. RV dilatation was significantly more common in expired patients (15% vs 29%, p = 0.026) and was associated with increased mortality in patients treated in the ICU (HR 2.966, 95%CI 1.067-8.243, p = 0.037), who did not need require positive pressure ventilation, IV pressor support or acute hemodialysis. CONCLUSIONS In hospitalized COVID-19 patients without a history of pulmonary hypertension, RV dilatation is associated with a 2-fold increase in inpatient mortality and a 3-fold increase in ICU mortality.
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Affiliation(s)
- Jozef Oweis
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America.
| | - Annie Leamon
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Ali H Al-Tarbsheh
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Katharine Goodspeed
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Ciril Khorolsky
- Department of Cardiology, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Usman Naseer
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Isam Albaba
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Sai Anoosh Parimi
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Boris Shkolnik
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Anupama Tiwari
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Mikhail Torosoff
- Department of Cardiology, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
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13
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Hodson M, Feustel P, Davis L. Sentinel lymph node biopsy in desmoplastic melanoma - the percent desmoplastic component matters: A systematic review. J Plast Reconstr Aesthet Surg 2022; 75:4441-4449. [PMID: 36283925 DOI: 10.1016/j.bjps.2022.08.044] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/28/2022] [Accepted: 08/18/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Desmoplastic melanoma (DM) is a less common form of cutaneous melanoma that has been described for decades; however, controversy remains regarding the management and use of sentinel lymph node biopsy (SLNB). The purpose of this study is to identify whether SLNB is indicated in all cases of DM, including the pure subtype. METHODS A systematic review was conducted using PubMed (with access to MEDLINE) along with the Cochrane Central Register of Controlled Trials from 2001 to 2019. Case series and case-control studies were included. RESULTS Eighteen studies were included for a total population of 3,914 patients. SLNB was performed in 2229 patients. The percentage of positive SLNB results was 8.5%. However, patients with pure DM (>90% desmoplastic component) were found to have a significantly lower rate of occult metastatic node positivity when compared with that of mixed DM (4.9% and 14.8%, respectively). CONCLUSIONS Our findings underscore the importance of the pathologist reporting percentage of desmoplastic component in melanoma. SLNB should be strongly considered for patients with mixed DM. However, the low rate of occult metastatic node positivity in pure DM is beneath the threshold for using SLNB as a staging procedure. SUMMARY Previous studies have suggested that desmoplastic melanoma is less likely to metastasize to regional lymph nodes when compared with conventional melanoma. This review suggests that it is imperative to distinguish the histologic subtype of desmoplastic melanoma to determine if staging procedure is indicated.
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Affiliation(s)
| | - Paul Feustel
- Albany Medical College, Albany, NY, United States
| | - Lindy Davis
- Division of Surgical Oncology, Department of Surgery, Albany Medical Center, 43 New Scotland Ave, Albany, NY 12208, United States.
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14
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Petchers A, Walker A, Bertram C, Feustel P, Singh TP, Zaman J. Evaluation of endoscopic gastrojejunostomy revision after Roux-en-Y gastric bypass for treatment of dumping syndrome. Gastrointest Endosc 2022; 96:639-644. [PMID: 35500660 DOI: 10.1016/j.gie.2022.04.1306] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 01/27/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Gastrojejunostomy stomal dilation is a frequent cause of weight regain after Roux-en-Y gastric bypass and may be a contributing cause of dumping syndrome. This study aims to evaluate the long-term durability of endoscopic gastrojejunostomy revision (EGJR) to resolve dumping syndrome. METHODS A retrospective chart review was performed of patients undergoing EGJR at a single institution from January 1, 2013 to December 1, 2018. The primary endpoint, dumping symptom resolution, was measured at 1 month and at the most recent postoperative follow-up. Continuous data are reported as mean and standard deviations and categorical data as percentages. The Fisher exact test was used to assess associations between categorical variables. RESULTS Ninety-eight patients underwent EGJR for dumping syndrome. Mean patient age was 51 years (standard deviation [SD], 9.9), and mean body mass index (BMI) was 36.2 kg/m2 (SD, 7.1), with most patients (53%) presenting with BMIs ≥35 kg/m2. Thirty-two patients (32%) reported severe dumping (≥3 symptoms). All patients were followed-up for 1 month, and 83% had a long-term follow-up at a mean of 3.45 years (SD, 1.7) after EGJR. In addition, 88% had initial symptom resolution at 1 month, and 85% reported symptom resolution 3 years postoperatively. Patients with GERD had a statistically significant improvement in dumping syndrome at 3 years compared with those without GERD (69% vs 62%, P = .03). Long-term weight loss averaged 2.1 pounds after EGJR. CONCLUSIONS EGJR is associated with effective and durable resolution of dumping syndrome at 3 years postoperatively, with a minimal long-term impact on weight loss. The presence of GERD preoperatively correlates with a statistically significant resolution of dumping syndrome.
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Affiliation(s)
- Adam Petchers
- Department of Surgery, Albany Medical Center, Albany, New York, USA
| | | | | | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, New York, USA
| | - T Paul Singh
- Department of Surgery, Albany Medical Center, Albany, New York, USA
| | - Jessica Zaman
- Department of Surgery, Albany Medical Center, Albany, New York, USA
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15
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Sundaram P, Bhatt V, Feustel P, Mian B. Burden of Prior Authorization Requirements on Urology Practice and Patients. Urology 2022; 169:76-83. [PMID: 35961563 DOI: 10.1016/j.urology.2022.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the final outcomes of various types of prior authorizations (PAs), and to quantify the administrative and financial burden of PAs on urology practice. PAs are often required before imaging, procedures or medications can be ordered. However, they can delay timely delivery of patient care and place a significant administrative burden on practices. The impact of PAs has been poorly studied, and no studies on PAs' burden on urology practice are available. METHODS Imaging and medications requiring PAs from an outpatient urology clinic from November 2020 to February 2021 were reviewed (n=267). Authorization outcomes were tracked to resolution. We calculated the time spent on PAs, and the estimated overall financial burden on the practice. RESULTS Of the PAs required, 60.6% were for imaging and 39.4% were for medications. Initial decision for PAs took a median of 2 days [IQR: 0-6, Range: 0-36], whereas decisions after an appeal (n=51) took a median of 10 days [IQR: 5-23, range 0-125 days]. Private insurance compared to Medicare or Medicaid, has an earlier time to decision (p=<0.001). Initial approval rates were 67.5%, and final approval rates after appeals were 88.2%. Of orders originally denied, a majority (77.3%) were appealed, 13.6% required alternative orders, and 7.6% paid out of pocket. The total cost to the practice was $2206.06, with a $15.11 mean cost of each PA. CONCLUSIONS PAs for imaging studies and medications pose a significant administrative and financial burden to urology patients and practice.
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Affiliation(s)
- Padmaja Sundaram
- Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, 518-262-5879.
| | - Vikas Bhatt
- Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, 518-262-5879.
| | - Paul Feustel
- Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, 518-262-5879.
| | - Badar Mian
- Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, 518-262-5879.
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16
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Donovan K, Manem N, Miller D, Yodice M, Kabbach G, Feustel P, Tadros M. The Impact of Patient Education Level on Split-Dose Colonoscopy Bowel Preparation for CRC Prevention. J Cancer Educ 2022; 37:1083-1088. [PMID: 33405208 PMCID: PMC7785930 DOI: 10.1007/s13187-020-01923-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AGA guidelines emphasize split-dose bowel preparation (BP) to ensure high-quality colonoscopy for the prevention of colorectal cancer (CRC). Split dose results in higher-quality preparation, but understanding instructions might be more difficult. Lower education levels may negatively influence BP quality. The confounding role of education level on BP quality was investigated. METHODS This was a cross-sectional study of 60 patients given split-dose BP. Patients consented and were asked three Likert scale questions based on BP instructions before the procedure. Compliance was self-reported. BP adequacy and the number of adenomas were recorded. BP was characterized as adequate (excellent, good) or inadequate (fair, poor). Data was analyzed with chi-square, odds ratio, Mann-Whitney, and regression analysis. RESULTS Thirty-one (52%) patients were high school graduates, 21 (38%) completed some college, and 6 (10%) were college graduates. College-educated patients had adequate BP (72%) more often than high school graduates (51%) (p = 0.02). Adenoma findings were not significantly different. The Likert scale mean ranks for patient understanding and reviewing of instructions were comparable between the two groups. Patient rating of scheduler explanations of the importance of following instructions was significantly better in the college group (mean ranks 2.59 and 1.83, respectively; p = 0.018). DISCUSSION Patient education level significantly affected the success of BP. Split BP can be more complex to comprehend, and instructions should consider patient education level. Specific intervention programs should be implemented to advise patients with less education that poor preparation may result in missed advanced neoplasias and subsequent procedures.
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Affiliation(s)
| | | | | | | | - Ghassan Kabbach
- Department of Internal Medicine, Albany Medical Center, Albany, NY 12208 USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY USA
| | - Micheal Tadros
- Department of Gastroenterology, Albany Medical Center Hospital, Albany, NY 12208 USA
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17
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Abulawi A, Al-Tarbsheh A, Leamon A, Feustel P, Chopra A, Batool A. Clinical Characteristics of Hospitalized COVID-19 Patients Who Have Gastrointestinal Bleeds Requiring Intervention: A Case-Control Study. Cureus 2022; 14:e26538. [PMID: 35936188 PMCID: PMC9345793 DOI: 10.7759/cureus.26538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is widely recognized as a disease that affects the respiratory system, although it can also present with significant extrapulmonary symptoms. Very few studies have suggested an increased risk of gastrointestinal (GI) bleeding. This study aimed to elucidate the incidence, etiology, risk factors, and outcomes of clinically significant GI bleeding requiring endoscopic intervention in patients with COVID-19. Methods This is a case-control (1:2) retrospective analysis of all hospitalized adult patients with COVID-19 infection admitted between March 1, 2020, and January 5, 2021, in which we compared patients with upper and lower GI bleeds to those without. Cases are defined as patients hospitalized with COVID-19 who had a GI bleed requiring intervention while controls are defined as patients hospitalized with COVID-19 who did not have a GI bleed. Of 1002 patients admitted to the Albany Medical Center with COVID-19 infection, there were 76 confirmed cases of GI bleeding. These patients were compared to a control group composed of randomly selected patients with COVID-19 infection who were admitted to Albany Medical Center over the same time period. We assessed patients for in-hospital mortality, ventilator-free days on day 28, ICU-free days on day 28, and hospital-free days on day 28. Additional information collected included demographic information, comorbid conditions, COVID-19 treatments received, endoscopy findings, endoscopic treatment received, and if the patients required a packed red blood cell transfusion. Results Out of 1007 patients hospitalized with COVID-19, 76 (8%) had a GI bleed requiring endoscopic intervention. Peptic ulcer disease in the stomach or duodenum was the most common finding. The use of steroids, antiplatelet agents, and anticoagulation was not associated with an increased risk of GI bleed in COVID-19 patients. The GI bleed group required ICU care in 37% (28/76) compared with 21% (32/152) in the control group, which was statistically significant (p=0.012; chi-square test). Length of hospital stay was longer in the GI bleed group (median 16 days IQR: 8 to 29 versus 7 days, IQR:4 to 16; p<0.001, Mann Whitney test). Conclusion Length of hospital stay and ICU level of care was higher in the GI bleed group of patients with COVID-19. ICU level of care was noted to be associated with an increased risk of GI bleeding. A GI bleed in COVID-19 patients could be from the virus's direct effect on the gut mucosa or stress-induced bleeding like any other severely sick ICU patient; however, this needs to be explored in future studies.
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18
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Al-Tarbsheh A, Chong W, Oweis J, Saha B, Feustel P, Leamon A, Chopra A. Clinical Outcomes of Early Versus Late Intubation in COVID-19 Patients. Cureus 2022; 14:e21669. [PMID: 35237472 PMCID: PMC8882044 DOI: 10.7759/cureus.21669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 01/08/2023] Open
Abstract
Background The implications of intubation timing in COVID-19 patients remain highly debatable due to the scarcity of available evidence. Objectives Our study aims to assess the clinical characteristics and outcomes of COVID-19 patients undergoing early intubation compared to those undergoing late intubation. Methods This is a single-center retrospective study of adult COVID-19 patients admitted between March 1, 2020 and January 10, 2021. Early intubation was defined as intubation within 24 hours of a) hospital admission; b) respiratory status deterioration requiring FiO2 60% and higher; or c) moderate/severe acute respiratory distress syndrome (ARDS) diagnosis. Results Among the 128 COVID-19 patients included, 66.4% required early intubation, and 33.6% required late intubation. The 28-day all-cause mortality and other outcomes of mechanical ventilation duration, hospital and ICU length of stay were equal regardless of intubation timing. Clinical characteristics, inflammatory markers, COVID-19 therapies, PaO2/FiO2 ratio, and pH were comparable for both groups. Better lung compliance was observed during early intubation than late intubation based on plateau (mean 21.3 vs. 25.5 cmH2O; P < 0.01) and peak pressure (mean 24.1 vs. 27.4 cmH2O; P = 0.04). Conclusions In critically ill COVID-19 patients, the timing of intubation was not significantly associated with poor clinical outcomes in the setting of matching clinical characteristics. More research is needed to determine which subset of patients may benefit from intubation and the predictors for optimal intubation timing.
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Affiliation(s)
| | - Woon Chong
- Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, USA
| | - Jozef Oweis
- Internal Medicine, Albany Medical Center, Albany, USA
| | - Biplab Saha
- Pulmonary and Critical Care, Ozark Medical Center, West Plan, USA
| | - Paul Feustel
- Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, USA
| | - Annie Leamon
- Internal Medicine, Albany Medical College, Albany, USA
| | - Amit Chopra
- Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, USA
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19
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Feustel P, Botti M, Andrews S. 123. Formal Pediatric Antimicrobial Stewardship Program at a Children’s Hospital Within a Larger Academic Medical Center Decreases Antimicrobial Prescribing. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Antimicrobial stewardship is a coordinated approach to antimicrobial overprescribing, an avoidable contributor to adverse events in children. Implementation of a formal pediatric antimicrobial stewardship program (pASP) in a children’s hospital within a hospital poses unique challenges due to staffing, funding, and institutional priorities. We hypothesized that a formalized pASP would decrease antimicrobial prescribing in a children’s hospital within a large academic medical center.
Methods
We extracted pharmacy administration data for all patients receiving systemic antimicrobials in a tertiary care, academic children’s hospital in Upstate NY from 3/1/2020-5/31/2021. We grouped patients into floor (including patients with surgical, hematologic, and oncologic processes), pediatric intensive care unit (PICU), and neonatal intensive care unit (NICU). We calculated antimicrobial days of therapy per 1000 patient days (DOT/1000PD) for 6 months before, 3 months during, and 6 months after institution of pASP. The formalized pASP involved physician and pharmacy leadership of prospective audit and feedback. We developed run charts and used two-way analysis of variance (ANOVA) with an effect of location, an effect of the intervention, and an interaction effect. Significant effects were then tested using Tukey’s test for multiple comparisons.
Results
Run charts are displayed in figures 1-3. Overall, the pediatric floor(DOT/1000PD=1181) had significantly higher prescribing than the PICU(847), which was significantly higher than the NICU(327) (p< 0.001, ANOVA). Antimicrobial prescribing after pASP dropped by 80 DOT/1000PD (98%CI: 23 to 137) (p=0.008; Tukey’s test) after including the effect of location. The interaction effect was not significant (p=0.77; ANOVA) suggesting that the intervention did not have a significantly different effect in the three locations.
Variation in Antimicrobial Prescribing on the Pediatric Floors
Variation in Antimicrobial Prescribing in the Pediatric Intensive Care Unit
Variation in Antimicrobial Prescribing in the Neonatal Intensive Care Unit
Conclusion
Antimicrobial prescribing decreased following implementation of a formalized pASP in a children’s hospital within a large academic medical center. Despite unique challenges with implementation in this environment, antimicrobial stewardship remains effective. Variation between floor, PICU, and NICU antimicrobial prescribing was also notable.
Disclosures
All Authors: No reported disclosures
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20
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Shah H, Feustel P, Davis L. Survivorship care plans and adherence with surveillance schedule in patients with invasive melanoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e24079] [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: 11/20/2022] Open
Abstract
e24079 Background: Melanoma accounts for 5.5% of new cancer diagnoses in the United States, and the 5-year overall survival is 93%. Overall, 7% of patients develop a recurrence, and 4-8% develop a second primary melanoma. This study aimed to assess how the standards set by the American College of Surgeons Commission on Cancer (CoC) to provide survivorship care plans (SCP) to patients may improve adherence to surveillance visits. Methods: All patients treated for invasive melanoma at our institution between 8/2018-2/2020 were included. SCP containing stage, treatment summary, and surveillance plan were delivered in-person to patients and sent to primary providers and dermatologists as outlined by CoC Standards for Optimal Care. Psychosocial distress (PSD) screening was performed using the National Comprehensive Cancer Network Distress Thermometer, with scores > 4 requiring further evaluation by oncology social worker. SCP and PSD were provided during the initiation phase of our cancer care program, and half the patients received services. Surveillance adherence was determined from chart review. The two groups were compared by t-test for continuous or chi-square test for categorical variables. Multiple regression analysis with odds ratios were performed. Mann-Whitney analysis was performed to assess the impact of SCP on PSD. Results: Of 146 patients identified for our cohort, 73 received SCP and PSD screening. Stage IA was the most common diagnosis (44%), followed by IB (13%) and IIIC (9%). Ninety-eight patients (67%) were adherent to all surveillance visits, and 55 of these received SCPs. Most patients noted low distress without the need for further support (79%), and 12 (21%) scored ≥4, benefiting from emotional and financial support and appointment and health insurance navigation. High PSD score did not correlate with advanced stage. Reception of SCP (p = 0.036) and close distance to treating facility (p = 0.016) improved adherence to surveillance visits. For patients who did not receive SCP, likelihood to follow up decreased by a factor of 0.469 (95% CI 0.231 - 0.952). Sex, age, PSD score, and stage did not affect surveillance adherence (p = NS). There were 6 recurrences, of which 4 were physician-detected during surveillance, and 8 patients developed second primary melanomas, all physician-detected. Conclusions: Delivery of SCP, a component of which includes counseling regarding signs and symptoms of recurrence or possibility of second primary melanoma, leads to significantly higher rates of surveillance adherence. This was shown for all stages. Melanoma survivors require close clinical follow-up, as demonstrated by our study finding that even with patient education, most recurrences and all new primary melanomas were physician-detected. PSD among melanoma patients is common, and all patients regardless of stage should undergo screening, as even early-stage patients exhibited distress.
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Affiliation(s)
| | - Paul Feustel
- Albany Medical College, Center for Neuropharmacology and Neuroscience, Albany, NY
| | - Lindy Davis
- Albany Medical College, Department of Surgery, Albany, NY
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21
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Ahsan L, Zheng W, Kaur G, Kadakuntla A, Remaley A, Sampson M, Feustel P, Nappi A, Mookherjee S, Lyubarova R. ASSOCIATION OF LIPOPROTEIN SUBFRACTIONS WITH PRESENCE AND SEVERITY OF CORONARY ARTERY DISEASE IN STATIN-NAÏVE PATIENTS REFERRED FOR CORONARY ANGIOGRAPHY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02924-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Manem N, Donovan K, Miller D, Yodice M, Wang K, Balogun K, Kabbach G, Feustel P, Tadros M. Open-access colonoscopy quality indicators and patient perception using split-dose bowel preparation. JGH Open 2021; 5:563-567. [PMID: 34013055 PMCID: PMC8114982 DOI: 10.1002/jgh3.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/08/2021] [Accepted: 03/11/2021] [Indexed: 11/12/2022]
Abstract
Background and Aim Open-access (OA) colonoscopies are defined as those scheduled without a gastrointestinal (GI) office visit. Past research has not focused on split preparation use and patient perception within OA. We aim to identify differences in bowel preparation (BP) adequacy, adenoma detection rate (ADR), self-reported compliance, and patient perception between OA and GI providers using split prep. Methods This was a cross-sectional study using split BP for colonoscopies. Patients completed a survey, and demographics, BP adequacy, and ADR were recorded. BP compliance was self-reported. Patients were asked three questions qualifying the BP instructions. Data were analyzed using chi square and Mann-Whitney tests by SPSS. Results BP adequacy was reported for 56 of 60 patients. Twenty-one participants (38%) were scheduled on OA, and 35 participants (62%) were scheduled after a GI office visit. Adequate BP was more frequent in 86% (18/21) of OA patients compared to 60% (21/35) in the GI group (P = 0.043). OA patients reported better review and explanation of the BP instructions compared to GI patients. There was no statistical difference between the demographics of the OA and GI groups or self-reported compliance and patient understanding of instructions. Conclusion OA scheduled colonoscopies were associated with more adequate BP. This could be explained by patients' self-motivation or an explanation of the importance of completing BP. This study supports the use of OA procedures as a standard of care.
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Affiliation(s)
| | | | | | | | - Katie Wang
- Division of Nephrology Stanford University School of Medicine Palo Alto California USA
| | - Khadijat Balogun
- Department of Gastroenterology Eastern Connecticut Healthcare Network Manchester Connecticut USA
| | - Ghassan Kabbach
- Department of Internal Medicine Albany Medical Center Albany New York USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics Albany Medical Center Hospital Albany New York USA
| | - Micheal Tadros
- Department of Gastroenterology Albany Medical Center Hospital Albany New York USA
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23
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Tucker HR, Mahoney E, Akhtar K, Kao TJ, Mamone G, Mikkilineni S, Ravi M, Watkins H, Terrelonge DL, Martin C, Unger K, Kim G, Fiber K, Gupta M, Indajang J, Kochman EM, Sachs N, Feustel P, Molho ES, Pilitsis JG, Shin DS. Motor Thalamic Deep Brain Stimulation Alters Cortical Activity and Shows Therapeutic Utility for Treatment of Parkinson's Disease Symptoms in a Rat Model. Neuroscience 2021; 460:88-106. [PMID: 33631218 DOI: 10.1016/j.neuroscience.2021.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/07/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
Deep brain stimulation (DBS) in Parkinson's disease (PD) alters neuronal function and network communication to improve motor symptoms. The subthalamic nucleus (STN) is the most common DBS target for PD, but some patients experience adverse effects on memory and cognition. Previously, we reported that DBS of the ventral anterior (VA) and ventrolateral (VL) nuclei of the thalamus and at the interface between the two (VA|VL), collectively VA-VL, relieved forelimb akinesia in the hemiparkinsonian 6-hydroxydopamine (6-OHDA) rat model. To determine the mechanism(s) underlying VA-VL DBS efficacy, we examined how motor cortical neurons respond to VA-VL DBS using single-unit recording electrodes in anesthetized 6-OHDA lesioned rats. VA-VL DBS increased spike frequencies of primary (M1) and secondary (M2) motor cortical pyramidal cells and M2, but not M1, interneurons. To explore the translational merits of VA-VL DBS, we compared the therapeutic window, rate of stimulation-induced dyskinesia onset, and effects on memory between VA-VL and STN DBS. VA-VL and STN DBS had comparable therapeutic windows, induced dyskinesia at similar rates in hemiparkinsonian rats, and adversely affected performance in the novel object recognition (NOR) test in cognitively normal and mildly impaired sham animals. Interestingly, a subset of sham rats with VA-VL implants showed severe cognitive deficits with DBS off. VA-VL DBS improved NOR test performance in these animals. We conclude that VA-VL DBS may exert its therapeutic effects by increasing pyramidal cell activity in the motor cortex and interneuron activity in the M2, with plausible potential to improve memory in PD.
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Affiliation(s)
- Heidi R Tucker
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Emily Mahoney
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Kainat Akhtar
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | - Gianna Mamone
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Saisree Mikkilineni
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Maya Ravi
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Hanel Watkins
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Danielle-Lee Terrelonge
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Caryn Martin
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Kristen Unger
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Gabrielle Kim
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Kyra Fiber
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Megan Gupta
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Jonathan Indajang
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Eliyahu M Kochman
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Natasha Sachs
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Paul Feustel
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Eric S Molho
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA; Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Damian S Shin
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA; Department of Neurology, Albany Medical Center, Albany, NY, USA.
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24
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Natenzon A, Parrott CW, Manem N, Gifford J, Feustel P, Griffy B, Zelig C. 125 Correlation between the updated chronic hypertension guidelines and cesarean delivery. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.147] [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: 11/17/2022]
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25
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Lende M, Feustel P, Alafifr R, Lynch T. 40 Assessing the association between BMI and blood pressures measured at alternative locations in obstetric patients. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Khazen O, Rosoklija G, Custozzo A, Gillogly M, Bridger C, Hobson E, Feustel P, Lambiase L, DiMarzio M, Pilitsis JG. Correlation Between Aspects of Perceived Patient Loneliness and Spinal Cord Stimulation Outcomes. Neuromodulation 2020; 24:150-155. [PMID: 33119206 DOI: 10.1111/ner.13299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Loneliness as a whole has been characterized as a health-related risk factor and is associated with worse outcomes after cardiac procedures. Evidence suggests that chronic pain patients are particularly vulnerable to feeling lonely. We examined the relationship between different aspects of loneliness and one-year postoperative outcomes after spinal cord stimulation (SCS) for chronic pain. MATERIALS AND METHODS We contacted 69 patients with thoracic SCS who had participated in our prospective outcomes database with one-year follow-up to complete the validated, abbreviated UCLA Loneliness Scale (UCLA-3). We examined responses on question 9 of the Oswestry Disability Index (ODI), question 12 of the Beck Depression Inventory (BDI), and UCLA-3 due to their relevance to different aspects of loneliness. We conducted regression analyses to determine the relationship between aspects of loneliness and pain outcomes. RESULTS We identified that loss of interest in people, companionship, and feeling excluded were associated with pain outcomes. Loss of interest in people was associated with improvement in pain (NRS worst p = 0.021, r = 0.32, NRS least p = 0.004, r = 0.4; NRS right now p = 0.016, r = 0.33). Companionship and feeling excluded were also associated with pain. We examined the interface between depression and total loneliness and found that while both were related to each other, depression was not associated with pain outcomes. CONCLUSIONS This study demonstrates an association between loss of interest in people, companionship, and feeling excluded and worse postoperative pain outcomes after receiving SCS. It identifies aspects of loneliness as important factors to consider when predicting the outcomes of SCS therapy for chronic pain control.
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Affiliation(s)
- Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Gavril Rosoklija
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Amanda Custozzo
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Michael Gillogly
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Cheyanne Bridger
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Ellie Hobson
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Laura Lambiase
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical College, Albany, NY, USA
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Ricciardelli RM, Walters NM, Pomerantz M, Metcalfe B, Afroze F, Ehlers M, Leduc L, Feustel P, Silverman E, Carl A. The efficacy of ketamine for postoperative pain control in adolescent patients undergoing spinal fusion surgery for idiopathic scoliosis. Spine Deform 2020; 8:433-440. [PMID: 32109313 DOI: 10.1007/s43390-020-00073-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 03/31/2019] [Accepted: 11/03/2019] [Indexed: 11/30/2022]
Abstract
The use of ketamine in conjunction with morphine to reduce postoperative pain has been explored in several different surgery subtypes with conflicting results. Ketamine has shown promise to have both opioid sparing and analgesic effects in the postoperative setting. This study aimed to elucidate ketamine's ability to reduce morphine equivalent consumption and improve patient satisfaction after spinal fusion surgery for the correction of idiopathic scoliosis. This surgery is known to be associated with significant postoperative pain which impedes the ability to improve patient satisfaction, and may complicate the recovery timeline. Currently, the standard therapeutic regimen consists of patient-controlled analgesia morphine and the use of other opioids such as hydromorphone. A prospective, randomized double-blinded, placebo-controlled trial was performed to compare the standard morphine equivalent therapy alone against a standard therapy in conjunction with ketamine. Fifty adolescent patients were enrolled and randomized. Results yielded a significant reduction in postoperative morphine equivalent consumption (p = 0.042), adjusted postoperative pain scores (p < 0.001), and incidence of nausea and vomiting (p = 0.045). The application of ketamine as an analgesic in conjunction with the current standard of morphine equivalent therapy may serve as a superior pain control regimen for spinal surgeries in young population. This regimen enhancement may be generalizable to other surgery subtypes within similar populations. LEVEL OF EVIDENCE: Level I.
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Affiliation(s)
| | - Noah M Walters
- Albany Medical College, Albany Medical Center, Albany, NY, USA
| | | | - Benjamin Metcalfe
- Department of Anesthesiology, University of Michigan Hospitals and Health Centers, Ann Arbor, USA
| | - Farzana Afroze
- Department of Anesthesiology, Albany Medical Center, Albany, USA
| | - Melissa Ehlers
- Department of Anesthesiology, Albany Medical Center, Albany, USA
| | - Laura Leduc
- Department of Anesthesiology, GHS Greenville Memorial Hospital, Greenville, USA
| | - Paul Feustel
- Albany Medical College, Albany Medical Center, Albany, NY, USA
| | - Eric Silverman
- Department of Anesthesiology, Albany Medical Center, Albany, USA
| | - Allen Carl
- Department of Orthopedic Surgery, Albany Medical Center, Albany, USA.
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28
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DiMarzio M, Madhavan R, Joel S, Hancu I, Fiveland E, Prusik J, Gillogly M, Rashid T, MacDonell J, Ashe J, Telkes I, Feustel P, Staudt MD, Shin DS, Durphy J, Hwang R, Hanspal E, Pilitsis JG. Use of Functional Magnetic Resonance Imaging to Assess How Motor Phenotypes of Parkinson's Disease Respond to Deep Brain Stimulation. Neuromodulation 2020; 23:515-524. [PMID: 32369255 DOI: 10.1111/ner.13160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/27/2019] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a well-accepted treatment of Parkinson's disease (PD). Motor phenotypes include tremor-dominant (TD), akinesia-rigidity (AR), and postural instability gait disorder (PIGD). The mechanism of action in how DBS modulates motor symptom relief remains unknown. OBJECTIVE Blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) was used to determine whether the functional activity varies in response to DBS depending on PD phenotypes. MATERIALS AND METHODS Subjects underwent an fMRI scan with DBS cycling ON and OFF. The effects of DBS cycling on BOLD activation in each phenotype were documented through voxel-wise analysis. For each region of interest, ANOVAs were performed using T-values and covariate analyses were conducted. Further, a correlation analysis was performed comparing stimulation settings to T-values. Lastly, T-values of subjects with motor improvement were compared to those who worsened. RESULTS As a group, BOLD activation with DBS-ON resulted in activation in the motor thalamus (p < 0.01) and globus pallidus externa (p < 0.01). AR patients had more activation in the supplementary motor area (SMA) compared to PIGD (p < 0.01) and TD cohorts (p < 0.01). Further, the AR cohort had more activation in primary motor cortex (MI) compared to the TD cohort (p = 0.02). Implanted nuclei (p = 0.01) and phenotype (p = <0.01) affected activity in MI and phenotype alone affected SMA activity (p = <0.01). A positive correlation was seen between thalamic activation and pulse-width (p = 0.03) and between caudate and total electrical energy delivered (p = 0.04). CONCLUSIONS These data suggest that DBS modulates network activity differently based on patient motor phenotype. Improved understanding of these differences may further our knowledge about the mechanisms of DBS action on PD motor symptoms and to optimize treatment.
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Affiliation(s)
- Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | | | | | | | - Julia Prusik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Michael Gillogly
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Tanweer Rashid
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Jacquelyn MacDonell
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | - Ilknur Telkes
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Damian S Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Roy Hwang
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Era Hanspal
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
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29
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Banerjee S, George MD, Singh S, Tchervenkov J, Van Heusen A, Tageldin M, Riley M, Shaukat MS, Demenagas N, Le K, Oliveira T, Kwon S, Feustel P, Kremer JM. Patient Perception of Cardiovascular Risk in Rheumatoid Arthritis. ACR Open Rheumatol 2020; 2:255-260. [PMID: 32314534 PMCID: PMC7231519 DOI: 10.1002/acr2.11136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/12/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) have higher incidence of cardiovascular diseases (CVDs) compared with age- and sex-matched controls. The objective of our study was to measure the knowledge of patients with RA about the association between their disease and cardiovascular (CV) risk and to measure the frequency of counseling by physicians based on patient report. METHODS A telephone survey was conducted among patients with RA enrolled in the Consortium of Rheumatology Researchers of North America RA registry to collect data on medical and social history and on knowledge about CVD risk in RA and how they learned about that risk. Multivariable logistic regression models were performed to determine the factors associated with patients' knowledge and factors influencing likelihood of physician counseling. The odds ratios (ORs) represent adjusted multivariable results. RESULTS Of 185 patients with RA included in the study, 87 patients (47%) were aware that RA was a CV risk factor. Older age (OR 0.6; 95% confidence interval [CI] 0.4-0.8 per decade) and smoking (OR 0.4; 95% CI 0.1-0.9) were associated with low awareness, whereas disease duration of more than 10 years (OR 5.2; 95% CI 2.2-12.1) was positively associated with patient knowledge. Counseling by physicians, mostly rheumatologists, on CV risk in RA was reported by 47 patients (25%). Disease duration of more than 10 years (OR 3.9; 95% CI 1.2-13.1) was positively associated with patient-reported counseling. Patients with hypertension were less likely to report counseling (OR 0.4; 95% CI 0.2-0.9). CONCLUSION Our study demonstrated low patient awareness of CV risk with RA and low rates of patient-reported counseling by physicians. This is an unmet need in clinical practice, which may be overcome by multimodal approaches such as developing websites, organizing symposiums, and involving health care providers at various levels.
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Affiliation(s)
| | | | | | | | - Amber Van Heusen
- Albany College of Pharmacy and Health Sciences, Albany, New York
| | | | | | | | | | - Kevin Le
- Albany College of Pharmacy and Health Sciences, Albany, New York
| | - Tiffany Oliveira
- Albany College of Pharmacy and Health Sciences, Albany, New York
| | - Sooyeon Kwon
- Albany Stratton Veterans Affairs Medical Center, Albany, New York
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30
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DiMarzio MD, Madhavan R, Joel S, Hancu I, Fiveland E, Prusik J, Gillogly M, Rashid T, Ashe J, Telkes I, Feustel P, Shin D, Durphy J, Hwang RS, Hanspal E, Pilitsis JG. Use of Functional Magnetic Resonance Imaging to Assess How Motor Phenotypes of Parkinson's Disease Respond to Deep Brain Stimulation. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_696] [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: 11/13/2022] Open
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31
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Shao MM, Liss A, Park YL, DiMarzio M, Prusik J, Hobson E, Adam O, Durphy J, Sukul V, Danisi F, Feustel P, Slyer J, Truong H, Pilitsis JG. Early Experience With New Generation Deep Brain Stimulation Leads in Parkinson's Disease and Essential Tremor Patients. Neuromodulation 2019; 23:537-542. [PMID: 31436001 DOI: 10.1111/ner.13034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/19/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Newer generation deep brain stimulation (DBS) systems have recently become available in the United States. Data on real-life experience are limited. We present our initial experience incorporating newer generation DBS with Parkinson's disease (PD) and essential tremor (ET) patients. Newer systems allow for smart energy delivery and more intuitive programming and hardware modifications including constant current and directional segmented contacts. METHODS We compared six-month outcomes between 42 newer generation and legacy leads implanted in 28 patients. Two cohorts each included 7 PD patients with bilateral subthalamic nucleus (STN) stimulation and 7 ET patients with unilateral ventral intermediate nucleus (VIM) stimulation of the thalamus. All directional leads included 6172 Infinity 8-Channel Directional leads and Infinity internal pulse generators (Abbott Neuromodulation, Plano, TX, USA) and nondirectional leads included lead 3389 with Activa SC for VIM and PC for STN (Medtronic, Minneapolis, MN, USA). RESULTS Six-month outcomes for medication reduction and motor score improvements between new and legacy DBS systems in PD and ET patients were similar. Directionality was employed in 1/3 of patients. Therapeutic window (difference between amplitude when initial symptom relief was obtained and when intolerable side effects appeared with the contact being used) was significantly greater in new DBS systems in both PD (p = 0.005) and ET (p = 0.035) patients. The windows for new and legacy systems were 3.60 V ± 0.42 and 2.00 V ± 0.32 for STN and 3.06 V ± 0.44 and 1.85 V ± 0.28 for VIM, respectively. DISCUSSION The therapeutic window of newer systems, whether or not directionality was used, was significantly greater than that of the legacy system, which suggests increased benefit and programming options. Improvements in hardware and programming interfaces in the newer systems may also contribute to wider therapeutic windows. We expect that as we alter workflow associated with newer technology, more patients will use directionality, and amplitudes will become lower.
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Affiliation(s)
- Miriam M Shao
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Andrea Liss
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Yunseo L Park
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julia Prusik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Ellie Hobson
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Octavian Adam
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Vishad Sukul
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Fabio Danisi
- Department of Neurology, Westchester Medical Center, Poughkeepsie, NY, USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julia Slyer
- Department of Neurology, Albany Medical Center, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Huy Truong
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neurology, Albany Medical Center, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
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Zhao X, Liao Y, Morgan S, Mathur R, Feustel P, Mazurkiewicz J, Qian J, Chang J, Mathern GW, Adamo MA, Ritaccio AL, Gruenthal M, Zhu X, Huang Y. Noninflammatory Changes of Microglia Are Sufficient to Cause Epilepsy. Cell Rep 2019; 22:2080-2093. [PMID: 29466735 PMCID: PMC5880308 DOI: 10.1016/j.celrep.2018.02.004] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [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: 09/18/2017] [Revised: 12/27/2017] [Accepted: 01/31/2018] [Indexed: 12/25/2022] Open
Abstract
Microglia are well known to play a critical role in maintaining brain homeostasis. However, their role in epileptogenesis has yet to be determined. Here, we demonstrate that elevated mTOR signaling in mouse microglia leads to phenotypic changes, including an amoeboid-like morphology, increased proliferation, and robust phagocytosis activity, but without a significant induction of pro-inflammatory cytokines. We further provide evidence that these noninflammatory changes in microglia disrupt homeostasis of the CNS, leading to reduced synapse density, marked microglial infiltration into hippocampal pyramidal layers, moderate neuronal degeneration, and massive proliferation of astrocytes. Moreover, the mice thus affected develop severe early-onset spontaneous recurrent seizures (SRSs). Therefore, we have revealed an epileptogenic mechanism that is independent of the microglial inflammatory response. Our data suggest that microglia could be an opportune target for epilepsy prevention.
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Affiliation(s)
- Xiaofeng Zhao
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA
| | - Yuan Liao
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY 12208, USA
| | - Shannon Morgan
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA
| | - Ramkumar Mathur
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY 12208, USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA
| | - Joseph Mazurkiewicz
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA
| | - Jiang Qian
- Department of Pathology, Albany Medical College, Albany, NY 12208, USA
| | - Julia Chang
- Department of Neurosurgery, Brain Research Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Gary W Mathern
- Department of Neurosurgery, Brain Research Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical College, Albany, NY 12208, USA
| | | | - Michael Gruenthal
- Department of Neurology, Albany Medical College, Albany, NY 12208, USA
| | - Xinjun Zhu
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY 12208, USA; Department of Medicine, Albany Medical College, Albany, NY 12208, USA
| | - Yunfei Huang
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA.
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33
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Kaszuba BC, Maietta T, Walling I, Feustel P, Stapleton A, Shin DS, Slyer J, Pilitsis JG. Effects of subthalamic deep brain stimulation with gabapentin and morphine on mechanical and thermal thresholds in 6-hydroxydopamine lesioned rats. Brain Res 2019; 1715:66-72. [PMID: 30898672 DOI: 10.1016/j.brainres.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/15/2019] [Accepted: 03/16/2019] [Indexed: 12/14/2022]
Abstract
Chronic pain is the most common non-motor symptom among Parkinson's disease (PD) patients, with 1.85 million estimated to be in debilitating pain by 2030. Subthalamic deep brain stimulation (STN DBS) programmed for treating PD motor symptoms has also been shown to significantly improve pain scores. However, even though most patients' pain symptoms improve or disappear, 74% of patients treated develop new pain symptoms within 8 years. Previously we have shown that duloxetine and STN high frequency stimulation (HFS) significantly increase mechanical thresholds more than either alone. The current project specifically investigates the effects of gabapentin and morphine alone and with high (150 Hz; HFS) and low (50 Hz; LFS) frequency stimulation in the 6-hydroxydopamine rat model for PD. We found that HFS, LFS, gabapentin 15 mg/kg and morphine 1 mg/kg all independently improve von Frey (VF) thresholds. Neither drug augments the HFS response significantly. Morphine at 1 mg/kg showed a trend to increasing thresholds compared to LFS alone (p = 0.062). Interestingly, gabapentin significantly reduced (p = 0.019) the improved VF thresholds and Randall Selitto thresholds seen with LFS. Thus, though neither drug augments DBS, we found effects of both compounds independently increase VF thresholds, informing use of our model of chronic pain in PD. Gabapentin's reversal of LFS effects warrants further exploration.
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Affiliation(s)
- Brian C Kaszuba
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Teresa Maietta
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Ian Walling
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Paul Feustel
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Amelia Stapleton
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Damian S Shin
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Julia Slyer
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States; Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
| | - Julie G Pilitsis
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States; Department of Neurosurgery, Albany Medical Center, Albany, NY, United States.
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Chaudhry R, Bilal A, Austin A, Mehta S, Salman L, Foulke L, Feustel P, Zuckerman R, Asif A. ANCA associated vasculitis: experience of a tertiary care referral center. ACTA ACUST UNITED AC 2018; 41:55-64. [PMID: 30095143 PMCID: PMC6534033 DOI: 10.1590/2175-8239-jbn-2018-0040] [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: 02/05/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022]
Abstract
Background and objectives: Anti-neutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis is a small vessel vasculitis with insufficient epidemiologic estimates in the United States. We aimed to determine demographic and clinical features of ANCA associated vasculitis patients presenting to a large tertiary care referral center in Upstate New York. Design, setting, participants, and measurements: A retrospective analysis of cases with pauci-immune GN on renal biopsy and clinical diagnosis of ANCA vasculitis presenting over 11 years was conducted. Outcomes of interest were: demographics, ANCA antibody positivity, patient and renal survival, and regional trends. Results: 986 biopsies were reviewed, 41 cases met the criteria for inclusion: 18 GPA, 19 MPA, and 4 double positive (anti-GBM disease plus ANCA vasculitis). Mean age at presentation was 52.4 years (SD 23.7), 23 (56%) were male and median creatinine was 2.6 mg/dL. The median patient follow up was 77 weeks (IQR 10 - 263 weeks), with a 3-month mortality rate of 5.7% and a 1-year estimated mortality rate of 12%. Thirteen patients required hemodialysis at the time of diagnosis; 7 patients came off dialysis, with median time to renal recovery of 4.86 weeks (IQR 1.57 - 23.85 weeks). C-ANCA positivity (p < 0.001) and C-ANCA plus PR3 antibody pairing (p = 0.005) was statistically significant in GPA versus MPA. P-ANCA positivity was observed in MPA versus GPA (p = 0.02) and double positive versus GPA (p = 0.002), with P-ANCA and MPO antibody pairing in MPA versus GPA (p = 0.044). Thirty-seven of the 41 cases were referred locally, 16 cases were from within a 15-mile radius of Albany, Schenectady, and Saratoga counties. Conclusions: ANCA vasculitis is associated with end stage renal disease and increased mortality. Our study suggests the possibility of higher regional incidence of pauci-immune GN in Upstate New York. Further studies should investigate the causes of clustering of cases to specific regions.
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Affiliation(s)
- Rafia Chaudhry
- Albany Medical College, Division of Nephrology and Hypertension, Albany, NY, USA
| | - Anum Bilal
- Albany Medical College, Division of Nephrology and Hypertension, Albany, NY, USA
| | - Adam Austin
- Albany Medical College, Division of Pulmonary Critical Care, Albany, NY, USA
| | - Swati Mehta
- Albany Medical College, Division of Nephrology and Hypertension, Albany, NY, USA
| | - Loay Salman
- Albany Medical College, Division of Nephrology and Hypertension, Albany, NY, USA
| | - Llewellyn Foulke
- Albany Medical College, Department of Pathology, Albany, NY, USA
| | - Paul Feustel
- Albany Medical College, Department of Neuroscience and Experimental Therapeutics, Albany, NY, USA
| | - Roman Zuckerman
- Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine, Neptune, NJ, USA
| | - Arif Asif
- Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine, Neptune, NJ, USA
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35
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Stein B, Smith C, Feustel P. MP57-01 THE EFFECT OF THE 2012 USPSTF ON PSA FOR PROSTATE CANCER SCREENING. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Mansouri W, Fordyce SB, Wu M, Jones D, Cohn D, Lin Q, Feustel P, Sharma T, Bennett JA, Andersen TT. Efficacy and tolerability of AFPep, a cyclic peptide with anti-breast cancer properties. Toxicol Appl Pharmacol 2018. [PMID: 29518411 DOI: 10.1016/j.taap.2018.03.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study is to assess the efficacy and safety profile of AFPep, a 9-amino acid cyclic peptide prior to its entry into pre-clinical toxicology analyses en route to clinical trials. METHODS AFPep was assessed for anti-estrogenic activity in a mouse uterine growth assay and for breast cancer therapeutic efficacy in a human tumor xenograft model in mice. AFPep was assessed for tolerability in a variety of in vivo models, notably including assessment for effects on rat liver and human hepatocellular carcinoma cell lines and xenografts. RESULTS AFPep arrests the growth of human MCF-7 breast cancer xenografts, inhibits the estrogen-induced growth of mouse uteri, and does not affect liver growth nor stimulate growth of human hepatocellular carcinoma cell lines when growing in vitro or as xenografts in vivo. AFPep is well tolerated in mice, rats, dogs, and primates. CONCLUSIONS AFPep is effective for the treatment of ER-positive breast cancer and exhibits a therapeutic index that is substantially wider than that for drugs currently in clinical use. The data emphasize the importance of pursuing pre-clinical toxicology studies with the intent to enter clinical trials.
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Affiliation(s)
- Wasila Mansouri
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, United States
| | - Samuel B Fordyce
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, United States; Rensselaer Polytechnic Institute, Rensselaer, NY, United States
| | - Matthew Wu
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, United States; Union College, Schenectady, NY, United States
| | - David Jones
- Department of Pathology, Albany Medical Center Hospital, Albany, NY, United States
| | - Douglas Cohn
- Animal Resource Facility, Albany Medical College, Albany, NY, United States
| | - Qishan Lin
- Center for Functional Genomics, University at Albany, Rensselaer, NY, United States
| | - Paul Feustel
- Deparment of Neuroscience and Experimental Therapeutics, Albany Medical College, United States
| | - Tanuj Sharma
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, United States; Rensselaer Polytechnic Institute, Rensselaer, NY, United States
| | - James A Bennett
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY, United States
| | - Thomas T Andersen
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, United States.
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Shah A, Ulmer W, Feustel P, O'Malley RL. Effects of patient gender on urologist decision-making regarding treatment of the localized renal mass introduction and objective. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.646] [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: 11/20/2022] Open
Abstract
646 Background: Gender disparity in the proportion of patients receiving nephron sparing strategies (NSS) for the treatment of localized renal masses has been demonstrated in large population series as well as in single centers of excellence. Reasons for the discrepancy remain elusive. We aimed to assess urologist treatment patterns for localized renal masses in both genders to gauge the existence of provider-based gender biases. We hypothesize that female patients may be recommended more aggressive treatment due to provider biases related to patient gender. Methods: Urologists were randomly emailed 1 of 2 surveys including 6 vignettes of various patients with renal masses. Both surveys were identical other than the vignette patient gender (VPG) which was male in 50% and female in 50%. Self-selected respondents chose the single best treatment option from the following choices: active surveillance (AS), percutaneous or laparoscopic ablation (ABL), partial nephrectomy (PN), and radical nephrectomy (RN). Fisher’s exact test was used to assess differences in treatment recommended based on VPG. Nominal logistic regression was performed to assess the magnitude of differences. Results: Of the 423 urologists who completed the survey there was an even response to both surveys (210 vs. 213). Most respondents were male (93%), married (89%) and in private practice (44%). Age and time practicing were evenly distributed and median number of nephrectomies done per year was 15. There were no significant differences in demographics between the respondents of the 2 surveys. When comparing AS, ABL, PN, and RN the only vignette that differed based on VPG was question 3 (p = 0.019). Comparison of any NSS vs. RN in question 3 showed male VPG was 1.67 times more likely to be recommended RN (p = 0.040). Urologist gender had no effect on these findings. Conclusions: In this survey study of practicing urologists we found that male patient gender increased recommendations for radical surgery and less nephron sparing strategies in a hypothetical older patient with a localized renal mass. Provider biases do not appear to be solely responsible for gender disparities seen in the treatment of a localized renal mass.
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Affiliation(s)
| | | | - Paul Feustel
- Albany Medical College, Center for Neuropharmacology and Neuroscience, Albany, NY
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Kumar V, Prusik J, Lin Y, Hwang R, Feustel P, Pilitsis JG. Efficacy of Alternating Conventional Stimulation and High Frequency Stimulation in Improving Spinal Cord Stimulation Outcomes: A Pilot Study. Neuromodulation 2018; 21:466-471. [PMID: 29405548 DOI: 10.1111/ner.12755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/06/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Spinal cord stimulation (SCS) is an established, effective method of treating chronic pain. High frequency stimulation (HFS) is an alternative SCS waveform that has been shown to alleviate pain but also necessitates more frequent recharging. The purpose of this pilot study is to evaluate efficacy of alternating conventional stimulation and HFS (termed "shuffle" stimulation) in improving SCS outcomes. METHODS Shuffle stimulation was designed to deliver conventional stimulation in upright positions with relative HFS in lying positions, automated through accelerometer technology. In this 13-week cross-over study, patients were randomized to receiving conventional and shuffle stimulation in four-week blocks. Pain outcomes and sensory testing were compared from preoperative baseline and at the conclusion of each study period. RESULTS Twelve patients completed this study. Two patients showed no change from baseline visual analogue scale (VAS) with either type of stimulation and were excluded from statistical analysis of pain outcomes. Mean numerical rating scale (NRS) scores assessing current pain were significantly lower in shuffle stimulation (4.0 ± 1.6) compared to conventional stimulation (5.8 ± 2.3) (p = 0.024). In the total cohort, 7 of 11 patients preferred shuffle over conventional stimulation. CONCLUSIONS This study generated preliminary evidence showing improved NRS current pain scores in shuffle stimulation compared to conventional stimulation. More patients preferred shuffle stimulation compared to conventional stimulation. Optimizing stimulation when patients are recumbent may increase patient satisfaction and pain control. The potential advantages of shuffle stimulation may warrant further investigation.
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Affiliation(s)
- Vignessh Kumar
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Julia Prusik
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Yufan Lin
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Roy Hwang
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany NY, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany NY, USA
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Mahon J, Helo S, Ellen J, Feustel P, Welliver R, McCullough A. 037 A Randomized Double Blinded Placebo Controlled Crossover Pilot Trial between Anastrozole and Clomiphene to Evaluate Improvement in Hypogonadal Symptoms and Erectile. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.056] [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: 11/26/2022]
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40
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Pani S, Cagino J, Feustel P, Musuku SR, Raja A, Bruno N, Ursillo C, Arunakul N, Poulos CM, Welljams-Dorof M, Roberts K, Torosoff M, Delago A. Patient Selection and Outcomes of Transfemoral Transcatheter Aortic Valve Replacement Performed with Monitored Anesthesia Care Versus General Anesthesia. J Cardiothorac Vasc Anesth 2017; 31:2049-2054. [DOI: 10.1053/j.jvca.2017.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Indexed: 11/11/2022]
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41
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Bennett JA, Mansouri W, Lin Q, Feustel P, Andersen TT. Pharmacodynamic and Pharmacokinetic Properties of AFPep, a Novel Peptide for the Treatment of Breast Cancer. Int J Pept Res Ther 2017. [DOI: 10.1007/s10989-017-9628-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Chockalingam A, Belasen A, Chen N, Ramirez-Zamora A, Youn Y, Feustel P, Wilock ME, Shin DS, Pilitsis JG. Effect of Eye Opening on Single-Unit Activity and Local Field Potentials in the Subthalamic Nucleus. Neuromodulation 2017; 20:471-477. [PMID: 28493348 DOI: 10.1111/ner.12606] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/17/2017] [Accepted: 03/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN DBS) is an established treatment in Parkinson's disease (PD). We investigate the effect of eye opening on neuronal activity and local field potentials (LFPs) in the STN. METHODS We prospectively enrolled 25 PD patients undergoing STN DBS in our institution. During DBS, single-unit activity (SUA) and LFPs were measured when eyes were open and closed. As movement is known to result in changes in LFPs, we tested response to eye opening in the presence and absence of movement. RESULTS Neither eye state nor arm movement has a significant influence on SUA recordings. There is a statistically significant interaction between eye state and arm movement (p < 0.05). In the presence of movement, STN SUA increase when eyes open (p < 0.05). When eyes are closed, STN SUA decrease with movement (p < 0.05). STN theta LFP oscillations decrease when eyes are open compared to closed, irrespective of movement status (p < 0.05). DISCUSSION STN activity is influenced by eye state and arm movement. It is unclear whether this is attributed to a change in the STN's role in oculomotor control or from a change in attentional state. Understanding how physiologic normal activity alters neural activity is critical for the optimization of DBS therapy, particularly in closed-loop neuromodulation.
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Affiliation(s)
| | - Abigail Belasen
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Nita Chen
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | | | - Youngwon Youn
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Meghan E Wilock
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Damian S Shin
- Department of Neurology, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
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Aleksic I, Sorokin I, Aggarwal H, Walker A, Feustel P, Kaufman R. MP24-20 EARLY AMBULATION DECREASES HOSPITAL LENGTH OF STAY IN RENAL TRAUMA: A RANDOMIZED, PROSPECTIVE STUDY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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44
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Shah A, Wynia B, Feustel P, Knuth J, Welliver C. PD09-11 MANAGEMENT OF THE POST-PUBERTAL UNDESCENDED TESTIS: AN UPDATED RISK ANALYSIS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Collison C, Prusik J, Paniccioli S, Briotte M, Grey R, Feustel P, Pilitsis JG. Prospective Study of the Use of Intraoperative Neuromonitoring in Determining Post-Operative Energy Requirements and Physiologic Midline in Spinal Cord Stimulation. Neuromodulation 2017; 20:575-581. [PMID: 28370852 DOI: 10.1111/ner.12590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 10/23/2016] [Revised: 12/12/2016] [Accepted: 01/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intraoperative neuromonitoring (IONM) through electromyography (EMG) studies has been shown to be a safe, effective way to determine the laterality of the spinal cord and guide electrode placement during spinal cord stimulation (SCS). However, the use of IONM to predict post-operative energy requirements and midline has not been examined and offers a new avenue to streamline programming and device selection. Further, the impact of cerebrospinal fluid (CSF) thickness on intraoperative and post-operative amplitudes is understood but has not been explicitly characterized. METHODS A total of 24 patients undergoing SCS implantation for chronic pain had intraoperative EMG studies performed to determine physiologic midline. The intraoperative midline was compared to the midline determined on post-operative day 1 based on paresthesia patterns during programming. For patients who had thoracic leads placed, the amplitudes needed to induce abdominal and extremity lateralization during SCS placement were compared with the intensities needed to induce therapy at post-operative day 1. Additionally, we examined whether CSF thickness, body mass index, diabetes, drug use, and smoking correlated with intraoperative and post-operative amplitudes. RESULTS Intraoperative EMG was able to predict post-operative paresthesia-based midline in 70.83% of patients. There was a statistically significant relationship between the intraoperative intensity needed to induce extremity lateralization with the post-operative intensity to induce therapy (p = 0.009) as well as the intraoperative intensity needed to stimulate abdominals with the post-operative intensity (p = 0.033). There was also a relationship seen between CSF thickness and the post-operative energy requirements in patients (p = 0.039). DISCUSSION EMG accurately predicts post-operative energy requirements and midline in SCS patients. While 29.17% of patients did not have a match between their intraoperative and post-operative midlines, EMG testing was still valuable in guiding electrode placement and providing information to predict post-operative intensities. Additionally, CSF thickness correlated with amplitude settings on the first post-operative day.
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Affiliation(s)
- Claire Collison
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Julia Prusik
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neurology, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | | | | | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
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46
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Chockalingam A, Boggs H, Prusik J, Ramirez-Zamora A, Feustel P, Belasen A, Youn Y, Fama C, Haller J, Pilitsis J. Evaluation of Quantitative Measurement Techniques for Head Tremor With Thalamic Deep Brain Stimulation. Neuromodulation 2017; 20:464-470. [DOI: 10.1111/ner.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/19/2016] [Accepted: 11/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Hans Boggs
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Julia Prusik
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
| | | | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
| | - Abigail Belasen
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Youngwon Youn
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Chris Fama
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Jessica Haller
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Julie Pilitsis
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
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47
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Welliver C, Benson AD, Frederick L, Leader B, Tirado E, Feustel P, Kontio J, McAsey M, Köhler TS. Analysis of semen parameters during 2 weeks of daily ejaculation: a first in humans study. Transl Androl Urol 2016; 5:749-755. [PMID: 27785432 PMCID: PMC5071206 DOI: 10.21037/tau.2016.08.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Timed and frequent intercourse around the time of female ovulation is recommended to improve conception. Although a significant number of articles have examined how the length of abstinence affects these semen analysis, the effects of frequent (daily) ejaculation has not been rigorously studied. Methods Twenty normal men were recruited for daily ejaculation over 14 consecutive days, after a 3–5 days abstinence period. Semen samples were collected at the beginning of the study (day 1) and then on days 3, 7 and 14. In addition to the standard semen analysis, markers of sperm DNA quality were assessed. Results The mean age of men completing the study was 25 years (range, 23–33 years). Significant decreases were observed in mean semen volume, total motile count (TMC) and sperm concentration during the study period without significant changes in motility or morphology. A large initial change in ejaculate volume, TMC and sperm concentration provided the primary difference in these values over the study period, with a plateau in values after this initial decrease (after study day 3). Metrics of DNA integrity did not change in a statistically or clinically meaningful way during the study period. Conclusions While a small study, this represents the most extensive examination of sperm quality with daily ejaculation. These findings generally support an approach of a short period of abstinence followed by daily copulation around ovulation to maximize the number of sperm available and optimize conception.
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Affiliation(s)
- Charles Welliver
- Division of Urology, Albany Medical College, Albany, NY 12208, USA; ; Albany Stratton Veterans Affairs Medical Center, Albany, NY 12208; USA; ; The Urological Institute of Northeastern New York, Albany, NY 12208, USA
| | | | - Luke Frederick
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
| | - Benjamin Leader
- Division of Clinical Research, ReproSource Inc., Woburn, MA 01801, USA
| | - Edna Tirado
- Division of Clinical Research, ReproSource Inc., Woburn, MA 01801, USA
| | - Paul Feustel
- Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY 12208, USA
| | - James Kontio
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
| | - Mary McAsey
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
| | - Tobias S Köhler
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
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48
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Helo S, Mahon J, Ellen J, Wiehle R, Fontenot G, Hsu K, Feustel P, Welliver C, McCullough A. Serum levels of enclomiphene and zuclomiphene in men with hypogonadism on long-term clomiphene citrate treatment. BJU Int 2016; 119:171-176. [DOI: 10.1111/bju.13625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sevann Helo
- Division of Urology; Albany Medical College; Albany NY USA
| | - Joseph Mahon
- Division of Urology; Albany Medical College; Albany NY USA
| | | | - Ron Wiehle
- Repros Therapeutics; The Woodlands TX USA
| | | | - Kuang Hsu
- Repros Therapeutics; The Woodlands TX USA
| | - Paul Feustel
- Department of Neuropharmacology and Neuroscience; Albany Medical College; Albany NY USA
| | - Charles Welliver
- Division of Urology; Albany Medical College; Albany NY USA
- Urological Institute of Northeastern New York; Division of Urology; Albany NY USA
| | - Andrew McCullough
- Division of Urology; Albany Medical College; Albany NY USA
- Urological Institute of Northeastern New York; Division of Urology; Albany NY USA
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Sorokin I, Welliver C, Feustel P, Parker A, Thompson J, Fontenot G, Wiehle R, McCullough A. PD07-08 CHANGES IN TESTICULAR VOLUME AND FUNCTION AFTER TESTOSTERONE REPLACEMENT VS. RESTORATION: ANALYSIS OF A RANDOMIZED, DOUBLE BLIND, PLACEBO-CONTROLLED TRIAL OF ENCLOMIPHENE CITRATE VS. ANDROGEL™ 1.62% IN MEN WITH SECONDARY HYPOGONADISM. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Rehfuss A, Feustel P, Kogan B. MP05-17 USE OF ULTRASOUND IN UROLOGY PRACTICE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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