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Edelstein R, Kilipiris GE, Machalekova K, Mouzalini E, Slobodianuk A, Javorka V. Accuracy of minor salivary gland biopsy in the diagnosis of Sjögren syndrome. ACTA ACUST UNITED AC 2021; 122:454-460. [PMID: 34161112 DOI: 10.4149/bll_2021_075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of this study was to find out the correlation and evaluate the accuracy of labial minor salivary gland biopsy as a diagnostic tool in the multidisciplinary management of patients with Sjögren syndrome. MATERIALS AND METHODS Patients, referred to our outpatient office between January 2014 and December 2018 from a rheumatologist for biopsy examination, as part of the complex diagnostic plan for suspected Sjögren syndrome, were included in the current study. Each specimen was examined histomorphometrically by the pathologist to calculate the focus score describing the degree of salivary gland inflammatory infiltration. RESULTS Fifty patients met the inclusion criteria. From the total number of patients, 39 presented with an established Sjögren syndrome by fulfilling the revised American-European criteria. From those, 27 had a positive lip biopsy. The remaining 12 patients from the total group, who were diagnosed with Sjögren syndrome based on the same criteria, had a negative lip biopsy. CONCLUSION The labial minor salivary gland biopsy is a valuable diagnostic tool to establish the diagnosis of Sjögren syndrome. However, a positive biopsy result must always be correlated with all the other diagnostic criteria to prove the exact diagnosis (Tab. 1, Fig. 4, Ref. 49). Text in PDF www.elis.sk Keywords: Sjögren syndrome, keratoconjunctivitis sicca, xerostomia, labial minor salivary glands, biopsy, focal lymphocytic infiltration, focus score.
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Sosa-Moreno A, Narita M, Spitters C, Swetky M, Podczervinski S, Lind ML, Holmberg L, Liu C, Edelstein R, Pergam SA. A Targeted Screening Program for Latent Tuberculosis Infection Among Hematopoietic Cell Transplant Recipients. Open Forum Infect Dis 2020; 7:ofaa224. [PMID: 32671130 PMCID: PMC7348235 DOI: 10.1093/ofid/ofaa224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/05/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND US hematopoietic cell transplantation (HCT) recipients have a low prevalence of latent tuberculosis infection (LTBI), but if latently infected they are at risk for progression to active tuberculosis. At our center, all HCT recipients underwent LTBI testing pretransplant by tuberculin skin testing (TST) until 2013 when we implemented a targeted screening program. Our objective was to assess the utility of our screening program that incorporated a pretransplant LTBI questionnaire to target TST and QuantiFERON TB Gold (QFT) testing. METHODS We performed a retrospective cohort study of HCT recipients undergoing first transplant from 2014 to 2016. Patients with positive, indeterminate, and a subset with negative QFT results underwent electronic medical record (EMR) review to assess TST results and risk factors for LTBI. RESULTS Among 1290 eligible recipients, 457 (35%) had at least 1 risk factor for LTBI on the pretransplant questionnaire; nonwhites were more likely to undergo LTBI testing (P < .0001). Overall, 16 of 1290 (1.2%) had at least 1 positive LTBI test. Of those screened by QFT, 14 of 457 (3%) were positive and 52 (11%) were indeterminate. Among those undergoing EMR review, 123 of 267 (46%) had TST records; 4 of 123 (3%) positive by both TST and QFT, and 2 (2%) by TST alone. Two or more risk factors were reported among the majority of LTBI-positive patients (15 of 16 [94%]). All patients with at least 1 positive test for LTBI (n = 16) were evaluated, and 11 of 16 (69%) were recommended to receive treatment. CONCLUSIONS Incorporating a pretransplant LTBI questionnaire allowed for an approximate 65% reduction in LTBI testing when compared with universal testing among this low prevalence population.
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Affiliation(s)
- Andrea Sosa-Moreno
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Masahiro Narita
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health-Seattle & King County, Seattle, Washington, USA
| | - Christopher Spitters
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health-Seattle & King County, Seattle, Washington, USA
| | - Michelle Swetky
- Infection Prevention, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | | | - Margaret L Lind
- School of Public Health, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Leona Holmberg
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Catherine Liu
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Raleigh Edelstein
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Steven A Pergam
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Infection Prevention, Seattle Cancer Care Alliance, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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3
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Etkin A, Maron-Katz A, Wu W, Fonzo GA, Huemer J, Vértes PE, Patenaude B, Richiardi J, Goodkind MS, Keller CJ, Ramos-Cejudo J, Zaiko YV, Peng KK, Shpigel E, Longwell P, Toll RT, Thompson A, Zack S, Gonzalez B, Edelstein R, Chen J, Akingbade I, Weiss E, Hart R, Mann S, Durkin K, Baete SH, Boada FE, Genfi A, Autea J, Newman J, Oathes DJ, Lindley SE, Abu-Amara D, Arnow BA, Crossley N, Hallmayer J, Fossati S, Rothbaum BO, Marmar CR, Bullmore ET, O'Hara R. Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder. Sci Transl Med 2020; 11:11/486/eaal3236. [PMID: 30944165 DOI: 10.1126/scitranslmed.aal3236] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/01/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022]
Abstract
A mechanistic understanding of the pathology of psychiatric disorders has been hampered by extensive heterogeneity in biology, symptoms, and behavior within diagnostic categories that are defined subjectively. We investigated whether leveraging individual differences in information-processing impairments in patients with post-traumatic stress disorder (PTSD) could reveal phenotypes within the disorder. We found that a subgroup of patients with PTSD from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) as revealed by functional magnetic resonance imaging (fMRI) neuroimaging and impaired verbal memory on a word list learning task. This combined phenotype was not associated with differences in symptoms or comorbidities, but nonetheless could be used to predict a poor response to psychotherapy, the best-validated treatment for PTSD. Using concurrent focal noninvasive transcranial magnetic stimulation and electroencephalography, we then identified alterations in neural signal flow in the VAN that were evoked by direct stimulation of that network. These alterations were associated with individual differences in functional fMRI connectivity within the VAN. Our findings define specific neurobiological mechanisms in a subgroup of patients with PTSD that could contribute to the poor response to psychotherapy.
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Affiliation(s)
- Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA. .,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Adi Maron-Katz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Wei Wu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510640, China
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Julia Huemer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Petra E Vértes
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0SZ, UK.,School of Mathematical Sciences, Queen Mary University of London, London E1 4NS, UK.,The Alan Turing Institute, London NW1 2DB, UK
| | - Brian Patenaude
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jonas Richiardi
- Department of Medical Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Madeleine S Goodkind
- New Mexico Veterans Affairs Healthcare System, Albuquerque, NM 87108, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jaime Ramos-Cejudo
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Yevgeniya V Zaiko
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Kathy K Peng
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Emmanuel Shpigel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Parker Longwell
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Russ T Toll
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Allison Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Sanno Zack
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Bryan Gonzalez
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Raleigh Edelstein
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jingyun Chen
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Irene Akingbade
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Elizabeth Weiss
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Roland Hart
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Silas Mann
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Kathleen Durkin
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Steven H Baete
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,New Mexico Veterans Affairs Healthcare System, Albuquerque, NM 87108, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Fernando E Boada
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Center for Advanced Imaging Innovation and Research (CAI2R), NYU School of Medicine, New York, NY 10016, USA.,Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
| | - Afia Genfi
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jillian Autea
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jennifer Newman
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Steven E Lindley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Nicolas Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, 6513677 Santiago, Chile.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Silvia Fossati
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Barbara O Rothbaum
- Trauma and Anxiety Recovery Program, Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Edward T Bullmore
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0SZ, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK.,ImmunoPsychiatry, Alternative Discovery and Development, GlaxoSmithKline, Stevenage SG1 2NY, UK
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
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4
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Fonzo GA, Goodkind MS, Oathes DJ, Zaiko YV, Harvey M, Peng KK, Weiss ME, Thompson AL, Zack SE, Mills-Finnerty CE, Rosenberg BM, Edelstein R, Wright RN, Kole CA, Lindley SE, Arnow BA, Jo B, Gross JJ, Rothbaum BO, Etkin A. Selective Effects of Psychotherapy on Frontopolar Cortical Function in PTSD. Am J Psychiatry 2017; 174:1175-1184. [PMID: 28715907 PMCID: PMC5711612 DOI: 10.1176/appi.ajp.2017.16091073] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but a comprehensive, emotion-focused perspective on how psychotherapy affects brain function is lacking. The authors assessed changes in brain function after prolonged exposure therapy across three emotional reactivity and regulation paradigms. METHOD Individuals with PTSD underwent functional MRI (fMRI) at rest and while completing three tasks assessing emotional reactivity and regulation. Individuals were then randomly assigned to immediate prolonged exposure treatment (N=36) or a waiting list condition (N=30) and underwent a second scan approximately 4 weeks after the last treatment session or a comparable waiting period, respectively. RESULTS Treatment-specific changes were observed only during cognitive reappraisal of negative images. Psychotherapy increased lateral frontopolar cortex activity and connectivity with the ventromedial prefrontal cortex/ventral striatum. Greater increases in frontopolar activation were associated with improvement in hyperarousal symptoms and psychological well-being. The frontopolar cortex also displayed a greater variety of temporal resting-state signal pattern changes after treatment. Concurrent transcranial magnetic stimulation and fMRI in healthy participants demonstrated that the lateral frontopolar cortex exerts downstream influence on the ventromedial prefrontal cortex/ventral striatum. CONCLUSIONS Changes in frontopolar function during deliberate regulation of negative affect is one key mechanism of adaptive psychotherapeutic change in PTSD. Given that frontopolar connectivity with ventromedial regions during emotion regulation is enhanced by psychotherapy and that the frontopolar cortex exerts downstream influence on ventromedial regions in healthy individuals, these findings inform a novel conceptualization of how psychotherapy works, and they identify a promising target for stimulation-based therapeutics.
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Affiliation(s)
- Gregory A. Fonzo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, Alto HeaStanford Neurosciences Institute, Stanford University, Stanford CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA,Correspondence To: Amit Etkin, M.D., Ph.D., 401 Quarry Road, MC 5797, Stanford, CA 94305; 650-725-5736;
| | - Madeleine S. Goodkind
- New Mexico Veterans Affairs Healthcare System, Albuquerque, NM, USA,Correspondence To: Amit Etkin, M.D., Ph.D., 401 Quarry Road, MC 5797, Stanford, CA 94305; 650-725-5736;
| | - Desmond J. Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yevgeniya V. Zaiko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, Alto HeaStanford Neurosciences Institute, Stanford University, Stanford CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
| | - Meredith Harvey
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
| | - Kathy K. Peng
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
| | - M. Elizabeth Weiss
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
| | - Allison L. Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sanno E. Zack
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Colleen E. Mills-Finnerty
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, Alto HeaStanford Neurosciences Institute, Stanford University, Stanford CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
| | - Benjamin M. Rosenberg
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Raleigh Edelstein
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, Alto HeaStanford Neurosciences Institute, Stanford University, Stanford CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
| | - Rachael N. Wright
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, Alto HeaStanford Neurosciences Institute, Stanford University, Stanford CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
| | - Carena A. Kole
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, Alto HeaStanford Neurosciences Institute, Stanford University, Stanford CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
| | - Steven E. Lindley
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
| | - Bruce A. Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - James J. Gross
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Barbara O. Rothbaum
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA, Alto HeaStanford Neurosciences Institute, Stanford University, Stanford CA, USA,Veterans Affairs Palolthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA
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5
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Pogodin P, Alkhazov G, Atamantchouk AG, Balatz MY, Bondar NF, Cooper PS, Dauwe LJ, Davidenko GV, Dersch U, Dolgolenko AG, Dzyubenko GB, Edelstein R, Emediato L, Endler AF, Engelfried J, Eschrich I, Escobar CO, Evdokimov AV, Filimonov IS, Garcia FG, Gaspero M, Giller I, Golovtsov VL, Gouffon P, Gülmez E, He K, Iori M, Jun SY, Kaya M, Kilmer J, Kim VT, Kochenda LM, Konorov I, Kozhevnikov AP, Krivshich AG, Krüger H, Kubantsev MA, Kubarovsky VP, Kulyavtsev AI, Kuropatkin NP, Kurshetsov VF, Kushnirenko A, Kwan S, Lach J, Lamberto A, Landsberg LG, Larin I, Leikin EM, Li Y, Luksys M, Lungov T, Maleev VP, Mao C, Mao D, Mao Z, Mathew P, Mattson M, Matveev V, McCliment E, Moinester MA, Molchanov VV, Morelos A, Nelson KD, Nemitkin AV, Neoustroev PV, Newsom C, Nilov AP, Nurushev SB, Ocherashvili A, de Oliveira E, Onel Y, Ozel E, Ozkurucuklu S, Penzo A, Petrenko SV, Procario M, Prutskoi VA, Ramberg E, Rappazzo GF, Razmyslovich BV, Rud VI, Russ J, Schiavon P, Simon J, Sitnikov AI, Skow D, Smith VJ, Srivastava M, Steiner V, Stepanov V, Stutte L, Svoiski M, Terentyev NK, Thomas GP, Uvarov LN, Vasiliev AN, Vavilov DV, Verebryusov VS, Victorov VA, Vishnyakov VE, Vorobyov AA, Vorwalter K, You J, Zhao W, Zheng S, Zukanovich-Funchal R. Polarization ofΣ+hyperons produced by 800 GeV/c protons on Cu and Be. Int J Clin Exp Med 2004. [DOI: 10.1103/physrevd.70.112005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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6
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Evdokimov AV, Akgun U, Alkhazov G, Amaro-Reyes J, Atamantchouk AG, Ayan AS, Balatz MY, Bondar NF, Cooper PS, Dauwe LJ, Davidenko GV, Dersch U, Dolgolenko AG, Dzyubenko GB, Edelstein R, Emediato L, Endler AMF, Engelfried J, Eschrich I, Escobar CO, Filimonov IS, Garcia FG, Gaspero M, Giller I, Golovtsov VL, Gouffon P, Gülmez E, Kangling H, Iori M, Jun SY, Kaya M, Kilmer J, Kim VT, Kochenda LM, Konorov I, Kozhevnikov AP, Krivshich AG, Krüger H, Kubantsev MA, Kubarovsky VP, Kulyavtsev AI, Kuropatkin NP, Kurshetsov VF, Kushnirenko A, Kwan S, Lach J, Lamberto A, Landsberg LG, Larin I, Leikin EM, Yunshan L, Luksys M, Lungov T, Maleev VP, Mao D, Chensheng M, Zhenlin M, Mathew P, Mattson M, Matveev V, McCliment E, Moinester MA, Molchanov VV, Morelos A, Nelson KD, Nemitkin AV, Neoustroev PV, Newsom C, Nilov AP, Nurushev SB, Ocherashvili A, Onel Y, Ozel E, Ozkorucuklu S, Penzo A, Petrenko SV, Pogodin P, Procario M, Ramberg E, Rappazzo GF, Razmyslovich BV, Rud VI, Russ J, Schiavon P, Simon J, Sitnikov AI, Skow D, Smith VJ, Srivastava M, Steiner V, Stepanov V, Stutte L, Svoiski M, Terentyev NK, Thomas GP, Torres I, Uvarov LN, Vasiliev AN, Vavilov DV, Vázquez-Jáuregui E, Verebryusov VS, Victorov VA, Vishnyakov VE, Vorobyov AA, Vorwalter K, You J, Wenheng Z, Shuchen Z, Zukanovich-Funchal R. Observation of a narrow charm-strange meson D(+)(sJ)(2632)-->D(+)(s)eta and D(0)K(+). Phys Rev Lett 2004; 93:242001. [PMID: 15697795 DOI: 10.1103/physrevlett.93.242001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Indexed: 05/24/2023]
Abstract
We report the first observation of a charm-strange meson D(+)(sJ)(2632) at a mass of 2632.5+/-1.7 MeV/c(2) in data from SELEX, the charm hadro-production experiment E781 at Fermilab. This state is seen in two decay modes, D(+)(s)eta and D0K+. In the D(+)(s)eta decay mode we observe a peak with 101 events over a combinatoric background of 54.9 events at a mass of 2635.4+/-3.3 MeV/c(2). There is a corresponding peak of 21 events over a background of 6.9 at 2631.5+/-2.0 MeV/c(2) in the decay mode D0K+. The decay width of this state is <17 MeV/c(2) at 90% confidence level. The relative branching ratio Gamma(D0K+)/Gamma(D(+)(s)eta) is 0.14+/-0.06. The mechanism that keeps this state narrow is unclear. Its decay pattern is also unusual, being dominated by the D(+)(s)eta decay mode.
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7
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Mattson M, Alkhazov G, Atamantchouk AG, Balatz MY, Bondar NF, Cooper PS, Dauwe LJ, Davidenko GV, Dersch U, Dolgolenko AG, Dzyubenko GB, Edelstein R, Emediato L, Endler AMF, Engelfried J, Eschrich I, Escobar CO, Evdokimov AV, Filimonov IS, Garcia FG, Gaspero M, Giller I, Golovtsov VL, Gouffon P, Gülmez E, Kangling H, Iori M, Jun SY, Kaya M, Kilmer J, Kim VT, Kochenda LM, Konorov I, Kozhevnikov AP, Krivshich AG, Krüger H, Kubantsev MA, Kubarovsky VP, Kulyavtsev AI, Kuropatkin NP, Kurshetsov VF, Kushnirenko A, Kwan S, Lach J, Lamberto A, Landsberg LG, Larin I, Leikin EM, Yunshan L, Luksys M, Lungov T, Maleev VP, Mao D, Chensheng M, Zhenlin M, Mathew P, Matveev V, McCliment E, Moinester MA, Molchanov VV, Morelos A, Nelson KD, Nemitkin AV, Neoustroev PV, Newsom C, Nilov AP, Nurushev SB, Ocherashvili A, Oliveira E, Onel Y, Ozel E, Ozkorucuklu S, Penzo A, Petrenko SV, Pogodin P, Procario M, Prutskoi VA, Ramberg E, Rappazzo GF, Razmyslovich BV, Rud VI, Russ J, Schiavon P, Simon J, Sitnikov AI, Skow D, Smith VJ, Srivastava M, Steiner V, Stepanov V, Stutte L, Svoiski M, Terentyev NK, Thomas GP, Uvarov LN, Vasiliev AN, Vavilov DV, Verebryusov VS, Victorov VA, Vishnyakov VE, Vorobyov AA, Vorwalter K, You J, Wenheng Z, Shuchen Z, Zukanovich-Funchal R. First observation of the doubly charmed baryon Xi(+)(cc). Phys Rev Lett 2002; 89:112001. [PMID: 12225136 DOI: 10.1103/physrevlett.89.112001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2002] [Indexed: 05/23/2023]
Abstract
We observe a signal for the doubly charmed baryon Xi(+)(cc) in the charged decay mode Xi(+)(cc)-->Lambda(+)(c)K-pi(+) in data from SELEX, the charm hadroproduction experiment at Fermilab. We observe an excess of 15.9 events over an expected background of 6.1+/-0.5 events, a statistical significance of 6.3sigma. The observed mass of this state is 3519+/-1 MeV/c(2). The Gaussian mass width of this state is 3 MeV/c(2), consistent with resolution; its lifetime is less than 33 fs at 90% confidence.
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Affiliation(s)
- M Mattson
- Carnegie-Mellon University, Pittsburgh, Pennsylvania 15213, USA
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8
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Kushnirenko A, Alkhazov G, Atamantchouk AG, Balatz MY, Bondar NF, Cooper PS, Dauwe LJ, Davidenko GV, Dersch U, Dolgolenko AG, Dzyubenko GB, Edelstein R, Emediato L, Endler AM, Engelfried J, Eschrich I, Escobar CO, Evdokimov AV, Filimonov IS, Garcia FG, Gaspero M, Giller I, Golovtsov VL, Gouffon P, Gülmez E, Kangling H, Iori M, Jun SY, Kaya M, Kilmer J, Kim VT, Kochenda LM, Konorov I, Kozhevnikov AP, Krivshich AG, Krüger H, Kubantsev MA, Kubarovsky VP, Kulyavtsev AI, Kuropatkin NP, Kurshetsov VF, Kwan S, Lach J, Lamberto A, Landsberg LG, Larin I, Leikin EM, Yunshan L, Luksys M, Lungov T, Maleev VP, Mao D, Chensheng M, Zhenlin M, Mathew P, Mattson M, Matveev V, McCliment E, Moinester MA, Molchanov VV, Morelos A, Nelson KD, Nemitkin AV, Neoustroev PV, Newsom C, Nilov AP, Nurushev SB, Ocherashvili A, Onel Y, Ozel E, Ozkorucuklu S, Penzo A, Petrenko SV, Pogodin P, Procario M, Prutskoi VA, Ramberg E, Rappazzo GF, Razmyslovich BV, Rud VI, Russ J, Schiavon P, Simon J, Sitnikov AI, Skow D, Smith VJ, Srivastava M, Steiner V, Stepanov V, Stutte L, Svoiski M, Terentyev NK, Thomas GP, Uvarov LN, Vasiliev AN, Vavilov DV, Verebryusov VS, Victorov VA, Vishnyakov VE, Vorobyov AA, Vorwalter K, You J, Wenheng Z, Shuchen Z, Zukanovich-Funchal R. Precision measurements of the lambda(+)(c) and D0 lifetimes. Phys Rev Lett 2001; 86:5243-5246. [PMID: 11384468 DOI: 10.1103/physrevlett.86.5243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2000] [Indexed: 05/23/2023]
Abstract
We report new precision measurements of the lifetimes of the Lambda(+)(c) and D0 from SELEX, the charm hadroproduction experiment at Fermilab. Based upon 1630 Lambda(+)(c) and 10 210 D0 decays we observe lifetimes of tau[Lambda(+)(c)] = 198.1+/-7.0+/-5.6 fs and tau[D0] = 407.9+/-6.0+/-4.3 fs.
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Affiliation(s)
- A Kushnirenko
- Carnegie-Mellon University, Pittsburgh, Pennsylvania 15213, USA
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9
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Macones GA, Hausman N, Edelstein R, Stamilio DM, Marder SJ. Predicting outcomes of trials of labor in women attempting vaginal birth after cesarean delivery: a comparison of multivariate methods with neural networks. Am J Obstet Gynecol 2001; 184:409-13. [PMID: 11228495 DOI: 10.1067/mob.2001.109386] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our aim was to assess the utility and effectiveness of a neural network for predicting the likelihood of success of a trial of labor, relative to standard multivariate predictive models. STUDY DESIGN We identified 100 failed trials of labor and 300 successful trials of labor in women with a prior cesarean delivery performed at our institution. Information was collected on >70 potential predictors of labor outcomes from the medical records, including demographic, historical, and past obstetric information, as well as information from the index pregnancy. Bivariate analyses comparing women in whom a trial of labor failed with those whose trial succeeded were performed. These initial analyses were used to select variables for inclusion into our muitivariate predictive model. From the same data we trained and tested a neural network, using a back-propagation algorithm. The test characteristics of the multivariate predictive model and the neural network were compared. RESULTS From the bivariate analysis a history of substance abuse (adjusted odds ratio, 0.27; 95% confidence interval, 0.09-0.80), a successful prior vaginal birth after cesarean delivery (adjusted odds ratio, 0.13; 95% confidence interval, 0.05-0.31), cervical dilatation at admission (adjusted odds ratio, 0.53; 95% confidence interval, 0.31-0.88), and the need for labor augmentation (adjusted odds ratio, 2.15; 95% confidence interval, 1.14-4.06) were ultimately discovered to be important in predicting the likelihood of the success or failure of a trial of labor. With these variables in the predictive model the sensitivity of the derived rule for predicting failure was 77%, the specificity was 65%, and the overall accuracy was 69%. We also built a network using the 4 variables that were included in the final multivariate model. We were unable to achieve the same degree of sensitivity and specificity that we observed with the regression-based predictive model (sensitivity and specificity, 59% and 44%). CONCLUSION In this study a standard multivariate model was better able to predict outcome in women ttempting a trial of labor.
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Affiliation(s)
- G A Macones
- Department of Obstetrics and Gynecology, the Center for Clinical Epidemiology and Biostatistics, and the Leonard Davis Institute for Health Economics, University of Pennsylvania School of Medicine, Philadelphia, USA
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10
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Roth J, Edelstein R. Diabetes/Metabolism reviews becomes Diabetes/Metabolism research and reviews. Diabetes Metab Res Rev 1999; 15:2. [PMID: 10398539 DOI: 10.1002/(sici)1520-7560(199901/02)15:1<2::aid-dmrr8>3.0.co;2-d] [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: 11/06/2022]
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11
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Abstract
Covalent attachment of functional proteins to a solid support is important for biosensors. One method employs thiol-terminal silanes and heterobifunctional crosslinkers such as N-succinimidyl 4-maleimidobutyrate (GMBS) to immobilize proteins through amino groups onto glass, silica, silicon or platinum surfaces. In this report, several heterobifunctional crosslinkers are compared to GMBS for their ability to immobilize active antibodies onto glass cover slips at a high density. Antibodies were immobilized at densities of 74-220 ng/cm2 with high levels of specific antigen binding. Carbohydrate-reactive crosslinkers were also compared to GMBS using a fiber optic biosensor to detect fluorescently-labeled antigen. At the concentrations tested, the antibodies immobilized with carbohydrate-reactive crosslinkers bound more antigen than GMBS immobilized antibodies as indicated by the fluorescence signal.
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Affiliation(s)
- L C Shriver-Lake
- Center for Bio/Molecular Science and Engineering, Naval Research Laboratory, Washington, DC 20375-5348, USA
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12
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Bonde J, Dahl R, Edelstein R, Kok-Jensen A, Lazer L, Punakivi L, Seppala A, Soes-Petersen U, Viskum K. The effect of RU 41.740, an immune modulating compound, in the prevention of acute exacerbations in patients with chronic bronchitis. Eur J Respir Dis 1986; 69:235-41. [PMID: 3545882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The effect of Biostim (RU 41.740), a new non-specific immune modulator, in reducing the number of acute exacerbations in patients with chronic bronchitis, was examined. One hundred and ninety-eight patients with chronic bronchitis stages 2 and 3 entered the study, which was conducted as a multicenter, double-blind, parallel three-group, placebo-controlled trial. The patients were randomised to placebo, Biostim 2 or 8 mg per day, and received treatment for 1 week every other week for 3 successive months during the winter 1983. A significant (p = 0.005) reduction in the number of acute exacerbations was observed in the patients treated with Biostim 2 mg/day, whereas no effect was observed in the placebo or 8 mg/day group. No serious side-effects were encountered.
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13
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Israël L, Samak R, Edelstein R, Amouroux J, Battesti JP, de Saint Florent G. In vivo nonspecific macrophage chemotaxis in cancer patients and its correlation with extent of disease, regional lymph node status, and disease-free survival. Cancer Res 1982; 42:2489-94. [PMID: 7074624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We have used a test to evaluate macrophage migration in vivo, derived from the technique of Rebuck. The test is based on counting the absolute number of macrophages that migrate into an inflammatory site determined by a standardized superficial skin abrasion. It was applied to the study of macrophage migration in cancer patients in different clinical situations. Macrophage migration was virtually abolished in patients with metastatic cancer as compared to healthy controls. In patients with resectable breast and lung tumors, the test performed preoperatively correlated closely with lymph node status as determined by pathological examination after operation. Patients without lymph node involvement showed a significantly stronger response than did controls, whereas those with lymph node involvement had a diminished or even an abolished response. Distinctive subgroups were characterized among patients both with and without lymph node involvement on the basis of their macrophage response, and these subgroups proved to have distinctly different prognoses, particularly the patients without lymph node involvement with a poor macrophage response who had an unusually poor prognosis. It is concluded that this test shows potential for predicting the prognosis among categories of patients hitherto considered as homogeneous, although further evaluation in larger numbers of patients is necessary.
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14
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Samak R, Edelstein R, Israel L. Immunosuppressive effect of acute-phase reactant proteins in vitro and its relevance to cancer. Cancer Immunol Immunother 1982; 13:38-43. [PMID: 6984354 PMCID: PMC11039047 DOI: 10.1007/bf00200198] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/1981] [Accepted: 02/02/1982] [Indexed: 01/22/2023]
Abstract
Acute-phase reactant proteins reach abnormally high levels in patients with cancer, and correlate with the extent of disease. In this study, several acute-phase glycoproteins, and serum albumin as a control, were tested at different concentrations for their ability to modify the blastogenic response of lymphocytes from 30 normal donors to PHA and the chemotactic response of monocytes from 15 normal donors to casein. In high concentrations approximating those found in cancer patients, but not in normal concentrations, haptoglobin and fibrinogen inhibited both functions to different degrees. Orosomucoid inhibited only monocyte chemotaxis, while ceruloplasmin and alpha 1-antitrypsin affected neither function. Increasing concentrations of PHA did not overcome the blocking effect of haptoglobin and fibrinogen on blastogenesis, suggesting that PHA-protein interaction was not responsible for the effect observed. The three proteins that did not suppress blastogenesis individually did so strongly when combined. It is suggested that these glycoproteins, synthesized by the liver in response to an inflammatory stimulus, may act as 'non-specific blocking factors' protecting tumors against the host's immunological attack. This non-specific blocking activity of the acute-phase proteins may contribute to the 'immune escape' of the tumor.
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15
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Niitsuma M, Golub SH, Edelstein R, Holmes EC. Lymphoid cells infiltrating human pulmonary tumors: effect of intralesional BCG injection. J Natl Cancer Inst 1981; 67:997-1003. [PMID: 6457925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Tumor-infiltrating lymphocytes (TIL) and regional lymph node lymphocytes (LNL) were isolated by mechanical disaggregation and density gradient centrifugation from 30 untreated human lung tumors and 12 BCG-injected human lung tumors. Lymphocyte populations were characterized by their ability to form erythrocyte (E)-rosettes, erythrocyte-antibody-complement, and erythrocyte-antibody gamma-rosettes, by their proportion of esterase-staining cells, and by their responses in mixed lymphocyte culture (MLC), cell-mediated lympholysis (CML). and natural killer (NK) assays. TIL from untreated tumors had low proportions of E-rosetting cells (mean, 27.3%), relatively high proportions of "null" cells, and poor responses in MLC-CML and NK assays. There were no significant differences between primary lung tumors and lung metastases in rosettes, MLC-CML responses, or NK activity. In contrast, TIL from tumors injected with BCG 14 days before resection had higher proportions of E-rosetting cells (47.8%) and vigorous MLC-CML and NK responses. LNL from 11 patients with untreated tumors had higher proportions of E-rosetting cells (40.5%) than LNL from 9 patients with BCG-injected tumors (35.0%) and LNL from patients with untreated tumors had higher responses than LNL from treated patients in MLC-CML assays. These results suggest that the BCG injection induced an infiltration of functionally reactive NK and T-cells at the tumor site without an associated increased activity of T-cells from regional lymph nodes.
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16
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Samak R, Edelstein R, Bogucki D, Samak M, Israël L. Testing the monocyte-macrophage system in human cancer. Biomedicine 1980; 32:165-9. [PMID: 7008857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The participation of the monocyte-macrophages cells in the host immune defence mechanisms against cancer has been recognized since a few years. Testing this component of host homeostasis appears as an additional tool necessary for evaluation of immune deficiency in cancer patient. We review here the most current tests used in the frame of such an evaluation, and also the most interesting results.
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17
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Samak R, Israel L, Edelstein R. Influence of tumor burden, tumor removal, immune stimulation, plasmapheresis on monocyte mobilization in cancer patients. Adv Exp Med Biol 1980; 121B:411-23. [PMID: 397757 DOI: 10.1007/978-1-4684-8914-9_38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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18
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Israël L, Edelstein R, McDonald J, Weiss J, Schein P. Immunological and plasma protein changes in cancer patients following a single plasmapheresis. Biomedicine 1978; 28:292-7. [PMID: 743556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Serial serum protein determinations and immunological monitoring were performed prior to and following a single 4 to 5 liter plasma exchange in 10 patients with disseminated cancer. The most consistent changes were observed for two initially elevated alpha globulins, acid glycoprotein and haptoglobin, which declined rapidly in all patients 1 hour after plasmapheresis and began to rise again as early as 24 hours post-plasmapheresis to reach initial levels by 72 hours. Among the immunological parameters T and B cell counts, and phytohemaglutinin-induced lymphocyte transformation showed little change. In 4 out of 10 patients C3 levels dropped at 1 hour post-plasmapheresis and continued to decline to 24 hours, suggesting that consumption of C3 possibly by macrophages may have occurred. In view of our earlier reports that repeated plasmapheresis induced partial tumor regressions in patients with disseminated cancer and that these regressions may have been related to depletion of immunosuppressive serum proteins, it is suggested that to maintain levels of these rapidly renewed proteins at a minimum for as long as possible, it is most appropriate to perform plasmapheresis every 48 hours rather than every 72 or 96 hours as was the case in the earlier study.
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19
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Israël L, Edelstein R. In vivo and in vitro studies on nonspecific blocking factors of host origin in cancer patients. Role of plasma exchange as an immunotherapeutic modality. Isr J Med Sci 1978; 14:105-30. [PMID: 632078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Experimental and clinical data are reviewed on elevated glycoprotein levels in tumor-bearing animals and patients at various stages of disease advancement. The authors report their findings in 232 patients with various solid tumors; these confirm and extend the reports in the literature. It is shown that some of these glycoproteins, rich in sialic acid, exhibit immunosuppressive properties in vitro, and it is suggested that tumors may protect themselves by triggering hepatic synthesis of sialoglycoproteins which "coat" the binding sites of both immunocompetent cells and tumor cells and thereby abrogate recognition and killing of the latter by the immune system. This concept of nonspecific blocking factors of host origin has already been substantiated to some extent by observations on the consequences of plasma exchange in 24 patients with metastatic tumors; eight of these patients exhibited an objective tumor regression. It is suggested that such studies should be extended to postoperative patients and that circulating sialoglycoprotein assays could be one of the ways of monitoring tumor growth, including growth during the nonvisible phase.
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20
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Israel L, Edelstein R, Mannoni P, Radot E, Greenspan EM. Plasmapheresis in patients with disseminated cancer: clinical results and correlation with changes in serum protein. The concept of "nonspecific blocking factors". Cancer 1977; 40:3146-54. [PMID: 589571 DOI: 10.1002/1097-0142(197712)40:6<3146::aid-cncr2820400659>3.0.co;2-n] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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21
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22
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Israël L, Depierre A, Choffel C, Milleron B, Edelstein R. Immunochemotherapy in 34 cases of oat cell carcinoma of the lung with 19 complete responses. Cancer Treat Rep 1977; 61:343-7. [PMID: 68827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Thirty-four previously untreated patients with oat cell carcinoma of the lung were treated with a myelotoxic combination of cyclophosphamide, adriamycin, methotrexate, CCNU, and Corynebacterium parvum (regimen A) every 4 weeks, interspersed with a non-myelotoxic combination including bleomycin, vincristine, dehydroemetine, and Corynebacterium parvum (regimen B) weekly the other 3 weeks or when hematologic toxicity prohibited administration of regimen A. Hematologic toxicity was frequent but was never a serious problem except in two cases of profound leukopenia in which fatal supervening infection occurred. Nineteen patients in this series (56%) showed a complete response lasting from 4+ to 65+ months. Eight of these patients are still alive with a followup of 6+ to 65+ months. Nine patients (26%) showed a partial response (greater than 50%) lasting 1-10+ months. Only one patient in this group is surviving (10+ months). The overall response rate was thus 82%. It is concluded from this study that only a complete response has any significant effect on survival, the benefit of a partial response over no response being only slight. The results achieved are compared to those of available series in the literature and from this comparison strategic deductions for the treatment of oat cell carcinoma of the lung are made.
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Israël L, Edelstein R, Depierre A, Dimitrov N. Daily intravenous infusions of Corynebacterium parvum in twenty patients with disseminated cancer: a preliminary report of clinical and biologic findings. J Natl Cancer Inst 1975; 55:29-33. [PMID: 1080521 DOI: 10.1093/jnci/55.1.29] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Twenty terminally ill patients with various disseminated tumors were treated with daily iv infusions of Corynebacterium parvum given alone at doses of 4 mg/day, 5 days/week, for 4-16 weeks. In 8 patients (40%), the lesions partially regressed to less than 50% of their original size. Another patient who did not improve with C. parvum therapy had a complete remission after the first course of chemotherapy. Skin tests, total leukocyte counts, and T- and B-cell counts revealed variable and unpredictable changes. Phytohemagglutinin- and concanavalin A-induced blastogenesis tended to increase. Of 10 patients, 8 had a significant decrease in serum C3 levels after completion of C. parvum therapy, possibly due to an increased C3 consumption by macrophages activated by the immunostimulant. That nonspecific immune stimulation after repeated iv infusions of an immunostimulant can by itself induce regression in disseminated disease does not agree with the current concept that immunotherapy can be effective only against minimal residual disease. The therapeutic procedure proposed here, though frequently associated with moderate short-lasting side effects, is devoid of serious toxicity.
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Israël L, Depierre A, Edelstein R, Cros-Decam J, Maury P. Effect of intranodular B.C.G. in 22 melanoma patients. Panminerva Med 1975; 17:187-8. [PMID: 1161317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Selman D, Edelstein R. So-called left atrial rhythm. N Y State J Med 1969; 69:1215-8. [PMID: 5256336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Edelstein R, Katz SS, Forgacs J. Supravalvular aortotomy infection. Caused by Listeria monocytogenes, masquerading as subacute bacterial endocarditis. Arch Intern Med 1965; 116:937-9. [PMID: 4954548 DOI: 10.1001/archinte.116.6.937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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