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Friedman D, Zimmerman S, Tan Z, Freeman J, Curtis J. Watchman device migration and embolization: a report from the NCDR LAAO registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Incomplete anchoring of the Watchman left atrial appendage closure (LAAO) device can result in substantial device migration or device embolization requiring percutaneous or surgical retrieval.
Purpose
To report rates and characteristics of in-hospital and post-discharge Watchman device migration and embolization events in the United States.
Methods
We performed a retrospective analysis of Watchman procedures (January 2016 through March 2021) reported to the National Cardiovascular Data Registry LAAO Registry. We excluded patients with prior LAAO interventions, no device released, and missing device information. In-hospital events were assessed among all patients and post-discharge events were assessed among patients with 45-day follow-up.
Results
Of 120,278 Watchman procedures, device migration or embolization occurred in 0.07% of patients (n=84) during the index hospitalization and surgery was performed in 39 patients. The in-hospital mortality rate was 14% among patients with device migration or embolization and 20.5% among patients who underwent surgery. In-hospital migration or embolization was more common: at hospitals with a lower median annual procedure volume (24 vs. 41 procedures, p<0.0001), with first-generation Watchman versus next-generation Watchman FLX devices (0.08% vs. 0.04%, p=0.0048), with larger LAA ostia (median 23 mm vs. 21 mm, p=0.004), and with a smaller difference between device and LAA ostial size (median difference 4 mm vs. 5 mm, p=0.04). There were no differences by age, sex, hospital type, hospital size, or teaching versus non-teaching status. Of 98,147 patients with 45-day follow-up, device migration or embolization after discharge occurred in 0.06% (n=54) patients and cardiac surgery was performed in 7.4% (n=4) of cases. The 45-day mortality rate was 3.7% (n=2) among patients with post-discharge device migration or embolization. Post-discharge migration or embolization was more common among men (79.7% of events but 58.9% of all procedures, p=0.0019), taller patients (177.9 cm vs. 172 cm, p=0.0005), and those with greater body mass (99.9 kg vs. 85.5 kg, p=0.0055); in contrast to in-hospital events, there were no differences in hospital volume, device characteristics, or LAA characteristics.
Conclusions
Watchman device migration or embolization is rare but associated with high mortality (Figure 1) and frequently requires surgical retrieval. A substantial proportion of all device migration or embolization cases occur after discharge and different patient and procedure characteristics are associated with in-hospital versus post-discharge cases. Given the morbidity and mortality associated with device migration or embolization, risk mitigation strategies and on-site cardiac surgical back-up are of paramount importance.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health
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Affiliation(s)
- D Friedman
- Duke University , Durham , United States of America
| | - S Zimmerman
- Yale University , New Haven , United States of America
| | - Z Tan
- Yale University , New Haven , United States of America
| | - J Freeman
- Yale University , New Haven , United States of America
| | - J Curtis
- Yale University , New Haven , United States of America
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Zimmerman S, Abdelkefi A. Enhanced design considerations on the buckling and dynamics of Gannet-inspired systems during water entry. Bioinspir Biomim 2020; 16:026011. [PMID: 33096538 DOI: 10.1088/1748-3190/abc468] [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] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/23/2020] [Indexed: 06/11/2023]
Abstract
To provide a more complete analysis of Gannet birds and Gannet-inspired drones during diving, this work considers an improved beam model to describe the static and dynamic characteristics of Gannet and Gannet-like drones at impact. The beam model consists of two different geometric and material property beams under continuity conditions to better understand the geometrical and material parameters' influence on the structural statics and dynamics of these kinds of systems. Using Hamilton's principle, the equations of motion, continuity, and boundary conditions considering Euler-Bernoulli and Timoshenko theories are derived. Then, applying the continuity and boundary conditions, the static and dynamic analyses are conducted to examine the impact buckling speeds, the buckled shapes, the natural frequencies at different impact velocities for bioinspired drone design, and the post-buckled mode shapes. The buckled configurations suggest that the body of the Gannet most likely has a different bending and torsional stiffness than the neck. The results indicate that the amount of softening in the joints contributes significantly to not only the speed at which the bird will buckle, but also the buckling profile of the bird. To obtain a physical buckling profile of the Gannet, a stiffer boundary condition at the end of the bird body model is needed due to the increased bending stiffness properties of the body compared to the neck as well as the position of the wings and feet surpassing the end of the body. The results also demonstrate that to build a bioinspired diving drone that falls within a smaller air-vehicle range, the amount of error between theories in predicting the static and dynamic buckling behavior of the system becomes significantly more evident. The dynamic characteristics and mode shapes of the Gannet-like systems are provided for further drone design insight on the impact speeds the drone can achieve without responding to an external excitation frequency from a propeller or actuator.
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Affiliation(s)
- S Zimmerman
- Department of Mechanical and Aerospace Engineering, New Mexico State University, Las Cruces, NM, 88003, United States of America
| | - A Abdelkefi
- Department of Mechanical and Aerospace Engineering, New Mexico State University, Las Cruces, NM, 88003, United States of America
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Orth J, Li Y, Simning A, Zimmerman S, Temkin‐Greener H. Nursing Home Residents with Dementia Experience Better End‐of‐Life Care and Outcomes in Nursing Homes with Alzheimer’s Special Care Units. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13349] [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: 11/27/2022] Open
Affiliation(s)
- J. Orth
- School of Medicine and Dentistry University of Rochester Rochester NY United States
| | - Y. Li
- University of Rochester Medical Center Rochester NY United States
| | - A. Simning
- University of Rochester Medical Center Rochester NY United States
| | - S. Zimmerman
- University of North Carolina at Chapel Hill Chapel Hill NC United States
| | - H. Temkin‐Greener
- School of Medicine and Dentistry University of Rochester Rochester NY United States
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Zimmerman S, Abdelkefi A. Investigations on the buckling and dynamics of diving-inspired systems when entering water. Bioinspir Biomim 2020; 15:036015. [PMID: 32066135 DOI: 10.1088/1748-3190/ab76d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This work provides comparative modeling approaches to determine the velocities and natural frequencies of plunge-diving bird and bioinspired drone systems when entering water. These systems are chosen to further explain the survival of diving birds as they impact water and to provide insight into the design geometry and material choice of bioinspired diving drones. A nonlinear reduced-order model is developed and utilized to analyze the dive at impact considering both Timoshenko and Euler-Bernoulli beam theories. Using Hamilton's principle, the equations of motion are first derived. Then, static and dynamic buckling analyses are conducted. For this study, a geometrically simplified cone-beam system is considered, where the cone represents the head and the beam represents both the neck and body of the plunge-diving systems. The first study is to analyze the effects different diving drone materials and cone dimensions play on the sensitivity of the system. The second study applies geometric parameters to the cone-beam system representative of a plunge-diving bird (Northern gannet) and a surface-diving bird (Double-crested cormorant). The results show that choosing a material with a higher Young's modulus and a cone with a smaller half angle increase the velocity at which buckling occurs. The buckling velocities of the predicted Northern gannet model appear to be much greater than the average recorded diving speeds, suggesting that the bird is capable of plunge-diving at more extreme conditions. The natural frequencies are found for the aforementioned plunge-diving systems to predict failure if any external frequencies are known to act on the system while on a mission, such as conditions dependent on the climate or environment. It is shown in all buckling studies that the Euler-Bernoulli beam theory consistently overestimates the responses when compared with the Timoshenko beam theory. In the dynamic responses, Euler-Bernoulli beam theory overestimates for the pre-buckling region, then underestimates at the start of the post-buckling region until a point where the two theories cross paths. The amount of error with Euler-Bernoulli beam theory depends heavily on the slenderness ratio of the beam due to the theory being a simplification of the Timoshenko beam theory. It is noted that as the development of a more realistic bird model improves, the thickness will become significant and the use of Euler-Bernoulli beam theory at the point of impact will no longer be a valid assumption.
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Affiliation(s)
- S Zimmerman
- Department of Mechanical and Aerospace Engineering, New Mexico State University, Las Cruces, NM 88003, United States of America
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Ireland C, Damico R, Kolb T, Mathai S, Zimmerman S, Shah A, Mukherjee M, Wigley F, Hassoun P, Kass D, Tedford R, Hsu S. Clinical Surrogates of Right Ventricular-Pulmonary Arterial Uncoupling. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.222] [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: 11/29/2022] Open
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Zimmerman S, Ceballes S, Taylor G, Chang B, Jung S, Abdelkefi A. Nonlinear modeling and experimental verification of Gannet-inspired beam systems during diving. Bioinspir Biomim 2019; 14:026002. [PMID: 30562725 DOI: 10.1088/1748-3190/aaf98c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A nonlinear model is proposed to answer at which diving speeds and beak angles will cause injury to Gannet-inspired beam systems during plunge-diving. In doing so, the critical velocities at which buckling occurs with various types of boundary conditions are first obtained for vertical dives and the resulting forces at the point of impact are determined. The Gannet-inspired system is modeled as an Euler-Bernoulli beam to represent the neck and body of the Gannet, while the head of the Gannet is modeled as a cone with varying half-angles. The experimental investigations of Gannet-like diving systems are first introduced to present the varying parameters and assumptions of the simplified model. Next, the resulting forces during impact are investigated and a study is conducted to compare various approximations of the drag coefficient for the cone-shaped head. Considering the mid-plane stretching nonlinearity, the equations of motion for the structural system under various types of boundary conditions are derived using the Hamilton's principle. The characteristic equations, buckled configurations, and critical velocities are determined for each set of boundary conditions. The results show that the system with the smallest half-beak angle and thus the lowest drag force and beam length delays the critical velocity and is most representative of a Gannet during diving. The obtained results demonstrate great agreement with the conducted experiments. For clamped-clamped boundary conditions, the critical velocity is found to be the greatest because of the increased stability at both ends of the beam. It is also noted that a nonlinear approximation for the coefficient of drag offers the best fit with the provided experimental values when compared to a hyperbolic tangent approximation, which predicts the coefficient of drag to be less than that obtained in experiments, and thus predicts that the systems will buckle at higher velocities.
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Affiliation(s)
- S Zimmerman
- Department of Mechanical and Aerospace Engineering, New Mexico State University, Las Cruces, NM 88003, United States of America
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Carder PC, Zimmerman S. INTEREST GROUP SESSION - ASSISTED LIVING: LICENSED NURSE AND ADMINISTRATOR CHARACTERISTICS IN U.S. RESIDENTIAL CARE COMMUNITIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P C Carder
- Portland State University, Portland, Oregon
| | - S Zimmerman
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina
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Sloane P, Zimmerman S, Silbersack J. MIGRATION OF U.S. AND CANADA RETIREES TO LATIN AMERICAN COLONIAL CITIES: LESSONS LEARNED. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - S Zimmerman
- School of Social Work, University of North Carolina
| | - J Silbersack
- Cecil G. Sheps Center for Health Services Research, University of North Carolina - Chapel Hill
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Zimmerman S, Sloane PD, Ward K, Miller S, Wretman C. CONSIDERATIONS REGARDING IMPLEMENTING NON-PHARMACOLOGICAL PRACTICES IN ASSISTED LIVING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Zimmerman
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina,United States
| | - P D Sloane
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - K Ward
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - S Miller
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - C Wretman
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
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Wallden B, Church S, Pekker I, Zimmerman S, Popa S, Sullivan A, Ngouenet C, Harris E, Dowidar N, Bergdahl A, Schaper C, Danaher P, Ferree S. Impact of tissue processing and interferents on the reproducibility and robustness of a multi-plex gene expression assay measuring tumor inflammation. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jeelani R, Chosed R, Zimmerman S, Chang T, Robinson R, Roudebush W. Blastocoel cell-free DNA content is related to changes in ploidy status (chromosomal loss/gain) in day-5 embryos. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.986] [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: 10/28/2022]
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Bahn J, Gao F, Li X, Zimmerman S, Chen K, Zhao C, Maneval D, Thompson C. PO-264 Preclinical studies with pegvorhyaluronidase alfa (PEGPH20) in combination with FOLFIRINOX (FFX) chemotherapy in models of pancreatic ductal adenocarcinoma. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
Abstract:It has been known for 70 years that the human pupil dilates when a person responds to a cognitive task. Further, it is known that parasympathetic pupillary innervation decreases with raised attention state while sympathetic innervation increases. But the information the pupil transmits during elevated attention states about such neurological dynamics and a quantitative measure of this information have defied statistical modelling. Now we describe experiments using a short-term memory task called an acoustic impulse test in which the pupillary dynamics in response to random acoustic impulses are recorded with a high resolution (0.01mm) pupillometer with the result that parasympathetic and sympathetic pupillary dilation components are quantifiable, as is the information transmitted by these components.
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Zimmerman S, Cohen L, Washington T, Ward K, Giorgio P. TOOLS FOR QUALITY IMPROVEMENT IN ASSISTED LIVING. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2587] [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: 11/12/2022] Open
Affiliation(s)
- S. Zimmerman
- University of North Carolina, Chapel Hill, North Carolina,
| | - L. Cohen
- Duke University, Durham, North Carolina,
| | | | - K. Ward
- University of North Carolina, Chapel Hill, North Carolina,
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Zimmerman S, Sloane P, Miller S, Reed D, Preisser J, Hanlon J. TREATING BEHAVIORAL SYMPTOMS OF DEMENTIA IN ASSISTED LIVING. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Zimmerman
- University of North Carolina, Chapel Hill, North Carolina,
| | - P.D. Sloane
- University of North Carolina, Chapel Hill, North Carolina,
| | - S. Miller
- University of North Carolina, Chapel Hill, North Carolina,
| | - D. Reed
- University of North Carolina, Chapel Hill, North Carolina,
| | - J. Preisser
- University of North Carolina, Chapel Hill, North Carolina,
| | - J.T. Hanlon
- University of Pittsburgh, Pittsburgh, Pennsylvania
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Degenholtz H, Zimmerman S, Resnick B. FROM EVIDENCE TO PRACTICE AND POLICY: TRANSLATING PROMISING PRACTICES INTO SUSTAINABLE PROGRAMS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - S. Zimmerman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - B. Resnick
- University of Maryland School of Nursing
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Zimmerman S, Reed D, Preisser J, Sloane P. ANTIBIOTIC STEWARDSHIP IN LONG-TERM CARE: RESULTS FROM AN IMPLEMENTATION STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S. Zimmerman
- University of North Carolina, Chapel Hill, North Carolina
| | - D. Reed
- University of North Carolina, Chapel Hill, North Carolina
| | - J. Preisser
- University of North Carolina, Chapel Hill, North Carolina
| | - P.D. Sloane
- University of North Carolina, Chapel Hill, North Carolina
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Zimmerman S, Gwyther L. IMPROVING DEMENTIA CARE AND OUTCOMES ACROSS SETTINGS OF CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S. Zimmerman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sloane P, Zimmerman S, Beeber A, Gwyther L, Matchar B, Lathren C, Ward K. HELPING FAMILY CAREGIVERS ATTEND TO MEDICAL SIGNS AND SYMPTOMS OF RELATIVES WITH DEMENTIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P.D. Sloane
- University of North Carolina, Chapel Hill, North Carolina,
| | - S. Zimmerman
- University of North Carolina, Chapel Hill, North Carolina,
| | - A.S. Beeber
- University of North Carolina, Chapel Hill, North Carolina,
| | | | | | - C. Lathren
- University of North Carolina, Chapel Hill, North Carolina,
| | - K. Ward
- University of North Carolina, Chapel Hill, North Carolina,
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Hanson L, Zimmerman S, Song M, Lin F, Rosemond C, Carey T, Mitchell S. PROMOTING GOALS OF CARE TO IMPROVE DECISION MAKING IN NURSING HOMES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L. Hanson
- University of North Carolina, Chapel Hill, North Carolina,
| | - S. Zimmerman
- University of North Carolina, Chapel Hill, North Carolina,
| | - M. Song
- Emory University, Atlanta, Georgia,
| | - F. Lin
- University of North Carolina, Chapel Hill, North Carolina,
| | - C. Rosemond
- University of North Carolina, Chapel Hill, North Carolina,
| | - T. Carey
- University of North Carolina, Chapel Hill, North Carolina,
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Kistler C, Sloane P, Zimmerman S. DECISION-MAKING AROUND DIAGNOSIS AND TREATMENT OF SUSPECTED INFECTIONS IN LONG-TERM CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C.E. Kistler
- University of North Carolina, Chapel Hill, North Carolina
| | - P.D. Sloane
- University of North Carolina, Chapel Hill, North Carolina
| | - S. Zimmerman
- University of North Carolina, Chapel Hill, North Carolina
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22
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Reuter R, Zimmerman S, Billars M. 0613 Development of an automated system for measuring supplement intake of grazing animals. J Anim Sci 2016. [DOI: 10.2527/jam2016-0613] [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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Zimmerman S, Zimmerman PR. 1199 Analysis and review of publicly available GreenFeed results. J Anim Sci 2016. [DOI: 10.2527/jam2016-1199] [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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Bahn JD, DesJardins C, Condon KB, Fathallah A, Zimmerman S, Maneval DC, Littlefield BA, Thompson CB. Abstract P1-03-09: Pegylated recombinant human hyaluronidase PH20 (PEGPH20) enhances efficacy of eribulin mesylate (HALAVEN®) in triple negative breast cancer xenografts. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-03-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Hyaluronan (hyaluronic acid, HA), a glycosaminoglycan found in tissue throughout the body, overaccumulates in the tumor microenvironment (TME) of many non-hematologic malignancies, including breast cancer. HA overaccumulation in breast cancer patients correlates with tumor progression and decreased survival (Tammi 2008). Pegylated recombinant human hyaluronidase PH20 (PEGPH20), an investigational therapeutic agent entering Phase 3 clinical development in pancreatic cancer, enzymatically removes HA from the TME. In preclinical animal models, PEGPH20-mediated HA degradation is associated with remodeling of the tumor stroma, reduction of tumor pressure, expansion of tumor blood vessels and facilitated delivery of chemotherapy (Thompson 2010, Provenzano 2012, Jacobetz 2013). Accordingly, preclinical studies investigated the combination of PEGPH20 with eribulin mesylate (ERI, HALAVEN®), a microtubule dynamics inhibitor with a novel mechanism of action (Towle 2001, Jordan 2005), currently approved for treatment of certain patients with advanced breast cancer. NCr nu/nu mice were inoculated subcutaneously with human triple-negative breast cancer (TNBC) HCC1806 or HCC1806/HAS3 cells; the latter subline was engineered to accumulate high HA levels, confirmed by immunohistochemistry, via overexpression of hyaluronan synthase 3 (HAS3). When tumors reached ∼350 mm3, animals were randomly assigned to four treatments groups: vehicle, ERI (0.7 mg/kg, IV, QW), PEGPH20 (37.5 µg/kg, IV, BIW), or ERI plus PEGPH20. In the parental HCC1806 model, addition of PEGPH20 did not significantly change the antitumor effects of ERI. In contrast, combining PEGPH20 with ERI in the HCC1806/HAS3 model increased the antitumor effects of ERI by 27% (94.5% vs. 119.7% TGI, ERI alone vs. ERI+PEGPH20, respectively; p=0.05) and resulted in 6 of 7 complete tumor regressions.
In a complementary study in HCC1806/HAS3 tumors evaluating ERI pharmacokinetics with and without PEGPH20, mice were assigned to three treatments groups: ERI (0.5 mg/kg, IV), simultaneous ERI plus PEGPH20 (37.5 µg/kg, IV); or ERI plus PEGPH20 predosed 24 h prior to ERI. Animals were sacrificed at 0.5, 1, 4, 24, 48, 72 and 96 h post ERI dose, and ERI levels in tumor, muscle, plasma and liver were subsequently analyzed by liquid/liquid extraction and LC-MS/MS chromatography. Simultaneous administration of ERI and PEGPH20 increased ERI maximum tumor concentration (Cmax) slightly and approximately doubled ERI tumor exposure (AUC); whereas the 24 h pretreatment with PEGPH20 approximately doubled ERI Cmax and increased ERI AUC more than two-fold. No significant differences in plasma ERI levels were observed between groups, and no significant differences in ERI levels in liver or muscle tissue were observed between groups. Taken together, these data suggest that PEGPH20-mediated HA removal significantly increases both ERI tumor concentrations and antitumor effectiveness in an HA-high TNBC model. A clinical phase 1b/2 clinical trial is planned to evaluate PEGPH20 plus ERI in first-line HER2-negative metastatic breast cancer.
Citation Format: Bahn JD, DesJardins C, Condon KB, Fathallah A, Zimmerman S, Maneval DC, Littlefield BA, Thompson CB. Pegylated recombinant human hyaluronidase PH20 (PEGPH20) enhances efficacy of eribulin mesylate (HALAVEN®) in triple negative breast cancer xenografts. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-03-09.
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Affiliation(s)
- JD Bahn
- Halozyme Therapeutics, San Diego, CA; Eisai Inc., Andover, MA
| | - C DesJardins
- Halozyme Therapeutics, San Diego, CA; Eisai Inc., Andover, MA
| | - KB Condon
- Halozyme Therapeutics, San Diego, CA; Eisai Inc., Andover, MA
| | - A Fathallah
- Halozyme Therapeutics, San Diego, CA; Eisai Inc., Andover, MA
| | - S Zimmerman
- Halozyme Therapeutics, San Diego, CA; Eisai Inc., Andover, MA
| | - DC Maneval
- Halozyme Therapeutics, San Diego, CA; Eisai Inc., Andover, MA
| | - BA Littlefield
- Halozyme Therapeutics, San Diego, CA; Eisai Inc., Andover, MA
| | - CB Thompson
- Halozyme Therapeutics, San Diego, CA; Eisai Inc., Andover, MA
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Huhtanen P, Cabezas-Garcia E, Utsumi S, Zimmerman S. Comparison of methods to determine methane emissions from dairy cows in farm conditions. J Dairy Sci 2015; 98:3394-409. [DOI: 10.3168/jds.2014-9118] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/23/2015] [Indexed: 11/19/2022]
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Sloane PD, Figueiro M, Garg S, Cohen LW, Reed D, Williams CS, Preisser J, Zimmerman S. Effect of home-based light treatment on persons with dementia and their caregivers. Light Res Technol 2015; 47:161-176. [PMID: 26273229 PMCID: PMC4530796 DOI: 10.1177/1477153513517255] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Sleep disorders are problematic for persons with dementia and their family caregivers. This randomized controlled trial with crossover evaluated the effects of an innovative blue-white light therapy on 17 pairs of home-dwelling persons with dementia and their caregivers. Subjects with dementia received blue-white light and control ('red-yellow' light) for six weeks separated by a four-week washout. Neither actigraphic nor most self-reported sleep measures significantly differed for subjects with dementia. For caregivers, both sleep and role strain improved. No evidence of retinal light toxicity was observed. Six weeks of modest doses of blue-white light appear to improve sleep in caregivers but not in persons with dementia. Greater or prolonged circadian stimulation may be needed to determine if light is an effective treatment for persons with dementia.
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Affiliation(s)
- PD Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - S Garg
- Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - LW Cohen
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - CS Williams
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Preisser
- Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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van Buul L, van der Steen J, Achterberg W, Schellevis F, Essink R, de Greeff S, Natsch S, Sloane P, Zimmerman S, Twisk J, Veenhuizen R, Hertogh C. O1.23: The effect of tailored antibiotic stewardship programmes on appropriateness of antibiotic prescribing in nursing homes. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zimmerman S, Cohen LW. The Challenge of Translating Culture Change. The Gerontologist 2014. [DOI: 10.1093/geront/gnu086] [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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Elliot A, Cohen LW, Reed D, Nolet K, Zimmerman S. A "Recipe" for Culture Change? Findings From the THRIVE Survey of Culture Change Adopters. The Gerontologist 2014; 54 Suppl 1:S17-24. [DOI: 10.1093/geront/gnt133] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Khurram I, Beinart R, Zipunnikov V, Calkins H, Nazarian S, Zimmerman S. Optimal Techniques for Late Gadolinium-Enhanced MRI: Comparison of Delay Time, Slice Thickness, and Multiplanar Reconstruction vs Maximum Intensity Projection for Assessment of Fibrosis in Atrial Fibrillation. Heart Rhythm 2013. [DOI: 10.1016/j.hrthm.2013.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rosenfeld JA, Kim KH, Angle B, Troxell R, Gorski JL, Westemeyer M, Frydman M, Senturias Y, Earl D, Torchia B, Schultz RA, Ellison JW, Tsuchiya K, Zimmerman S, Smolarek TA, Ballif BC, Shaffer LG. Further Evidence of Contrasting Phenotypes Caused by Reciprocal Deletions and Duplications: Duplication of NSD1 Causes Growth Retardation and Microcephaly. Mol Syndromol 2013; 3:247-54. [PMID: 23599694 DOI: 10.1159/000345578] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2012] [Indexed: 12/15/2022] Open
Abstract
Microduplications of the Sotos syndrome region containing NSD1 on 5q35 have recently been proposed to cause a syndrome of microcephaly, short stature and developmental delay. To further characterize this emerging syndrome, we report the clinical details of 12 individuals from 8 families found to have interstitial duplications involving NSD1, ranging in size from 370 kb to 3.7 Mb. All individuals are microcephalic, and height and childhood weight range from below average to severely restricted. Mild-to-moderate learning disabilities and/or developmental delay are present in all individuals, including carrier family members of probands; dysmorphic features and digital anomalies are present in a majority. Craniosynostosis is present in the individual with the largest duplication, though the duplication does not include MSX2, mutations of which can cause craniosynostosis, on 5q35.2. A comparison of the smallest duplication in our cohort that includes the entire NSD1 gene to the individual with the largest duplication that only partially overlaps NSD1 suggests that whole-gene duplication of NSD1 in and of itself may be sufficient to cause the abnormal growth parameters seen in these patients. NSD1 duplications may therefore be added to a growing list of copy number variations for which deletion and duplication of specific genes have contrasting effects on body development.
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Affiliation(s)
- J A Rosenfeld
- Signature Genomic Laboratories, PerkinElmer, Inc., Spokane, Wash., USA
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Koziol-McLain J, Ritchie M, Zimmerman S. VIOLENCE INTERVENTION PROGRAMME (VIP); IMPROVING NEW ZEALAND'S HEALTH SYSTEM RESPONSE TO FAMILY VIOLENCE. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580f.12] [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: 11/03/2022]
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Kultti A, Zimmerman S, Huang L, Jadin L, Jiang P, Frost G, Shepard H, Huang J. 325 Mesenchymal Stem Cells Promote Proliferation of Breast Cancer Cells Via Hyaluronan-CD44 Interaction. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71016-x] [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: 11/28/2022]
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Lev S, Gasparich G, Choi F, King L, Moore J, Zimmerman S. Establishing the detection threshold for Bacillus subtilis in a complex matrix using an inorganic fingerprint approach. Talanta 2011; 85:1734-7. [DOI: 10.1016/j.talanta.2011.06.072] [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] [Received: 05/25/2011] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 10/18/2022]
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Jolley CJ, Zimmerman S, Shah S, Davison N, Singh S. P207 Obstructive sleep apnoea in patients undergoing bariatric surgery--a London teaching hospital experience. Thorax 2010. [DOI: 10.1136/thx.2010.151068.8] [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: 11/03/2022]
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Cook T, Zimmerman S, Kim W, Boonn W. TH-C-201B-11: Automated Extraction and Reporting of Dose Information from Computed Tomography Examinations. Med Phys 2010. [DOI: 10.1118/1.3469528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Zimmerman S, Cook T, Kim W, Boonn W. TH-C-201B-01: Changes in Radiation Dose of Abdominal and Pelvic Computed Tomography Examinations over a Seven Year Period. Med Phys 2010. [DOI: 10.1118/1.3469518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Magnusson R, Shokooh-Saremi M, Hu Y, Lee KJ, Platzer SJW, Nebioglu AK, Zimmerman S, Wawro D. Fabrication of guided-mode resonance elements by nanoimprint lithography. J Nanosci Nanotechnol 2010; 10:1606-1615. [PMID: 20355547 DOI: 10.1166/jnn.2010.2040] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This paper addresses utilization of nanoimprint lithography for fabrication of nanopatterned resonant photonic elements. These compact periodic films resonate sharply when illuminated with light. The attendant spectral and angular signatures are useful in design of photonic devices for various applications. It is of interest to design and optimize resonant leaky-mode elements with prescribed filtering, polarization, and security attributes. Applying nanoimprint lithography techniques, we fabricate prototype devices using polymer materials produced by Dymax Corporation. The initial prototypes are designed for use in the near-IR and telecommunications spectral regions. We apply holographic surface-relief gratings as master templates. With these templates, we have formed submasters in PDMS (polydimethylsiloxane) to function as imprint stamps for the soft lithography steps. Using these submasters, we fabricate periodic surfaces in UV-curable polymers with resonant films deposited on the surface by sputtering. Several example devices possessing resonance efficiencies exceeding 90% are presented along with their spectral and angular characteristics.
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Affiliation(s)
- R Magnusson
- Department of Electrical Engineering, University of Texas at Arlington, Box 19016, Arlington, Texas 76019, USA
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Postolache T, Zimmerman S, Lapidus M, Cabassa J, D'Agostino D, Langenberg P, Tonelli L. Changes in Severity of Allergy and Anxiety Symptoms Are Positively Correlated in Patients with Recurrent Mood Disorders Who Are Exposed to Seasonal Peaks of Aeroallergens. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.900] [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: 11/30/2022]
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Stearns SC, Park J, Zimmerman S, Gruber-Baldini AL, Konrad TR, Sloane PD. Determinants and Effects of Nurse Staffing Intensity and Skill Mix in Residential Care/Assisted Living Settings. The Gerontologist 2007; 47:662-71. [DOI: 10.1093/geront/47.5.662] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Bobe G, Zimmerman S, Hammond EG, Freeman AE, Porter PA, Luhman CM, Beitz DC. Butter composition and texture from cows with different milk fatty acid compositions fed fish oil or roasted soybeans. J Dairy Sci 2007; 90:2596-603. [PMID: 17517699 DOI: 10.3168/jds.2006-875] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Changing the milk fatty acid composition can improve the nutritional and physical properties of dairy products and their acceptability to consumers. A more healthful milk fatty acid composition can be achieved by altering the cow's diet, for example, by feeding supplemental fish oil (FO) or roasted soybeans (RSB), or by selecting cows with a more unsaturated milk fatty acid composition. We examined whether feeding supplemental FO or RSB to cows that had a more unsaturated milk fatty acid composition acted additively to produce butter with improved fatty acid composition and texture. Using a 3 x 3 Latin square design with 2 replications, we fed diets to multiparous Holstein cows (60 to 200 DIM) chosen for producing either more or less unsaturated milk fatty acid composition (n = 6 for each group) for three 3-wk periods. The control diet contained 3.7% crude fat and the 2 experimental diets contained, on a dry matter basis, 0.8% of additional lipids in the form of 0.9% of FO or 5% of RSB. The milk, collected in the third week of feeding, was used to make butter, which was analyzed for its fatty acid composition and physical properties. Dry matter intake, milk yield, and milk composition were not significantly affected by cow diet or by cow selection. Cows that produced a more unsaturated and healthful milk fat prior to the feeding study, according to a "health-promoting index" [HPI = (sum of % of unsaturated fatty acids)/ (%12:0 + 4 x %14:0 + %16:0)], maintained a higher HPI in their butter during the feeding study than did cows with a low HPI. Milk from cows fed supplemental FO or RSB yielded more unsaturated butters with a higher HPI. This butter also was softer when the cows were fed RSB. Feeding RSB to cows chosen for their high milk HPI yielded the most unsaturated butter with the highest HPI and softest texture. Thus, selecting cows with a more health-promoting milk fatty acid composition and feeding supplemental RSB can be used in combination to produce butter that has a consumer-friendly texture and a healthful fatty acid profile.
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Affiliation(s)
- G Bobe
- Department of Animal Science, Iowa State University, Ames 50011, USA
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Dowling NF, Beckman MG, Manco-Johnson M, Hassell K, Philipp CS, Michaels LA, Moll S, Heit JA, Penner J, Kulkarni R, Pipe S, Bockenstedt P, Andersen J, Crudder S, James AH, Zimmerman S, Ortel TL. The U.S. Thrombosis and Hemostasis Centers pilot sites program. J Thromb Thrombolysis 2006; 23:1-7. [PMID: 17111206 DOI: 10.1007/s11239-006-9002-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Venous thromboembolism (VTE) is a common disorder associated with significant morbidity and mortality. Despite important advances in understanding the etiology of VTE, delivery of care to patients with thrombosis and thrombophilia is frequently incomplete and highly variable. A comprehensive model of health care has been used successfully to treat and prevent complications for people with hemophilia and other chronic disorders. The effectiveness of an integrated healthcare model for patients with all coagulation disorders has yet to be evaluated. The Division of Hereditary Blood Disorders of the Centers for Disease Control and Prevention (CDC) is collaborating with eight Thrombosis and Hemostasis Centers (pilot sites) to provide health-related services and conduct research directed toward the reduction or prevention of complications of thrombosis and thrombophilia. The initial objectives of the collaboration are to (1) determine the efficacy of integrated multidisciplinary care and prevention services for people with hemostatic disorders, (2) assess unmet needs for service delivery and identify outreach strategies to improve access to care, (3) develop effective messages aimed at disease management and prevention, and (4) foster the development of training programs to enhance provider skills for the delivery of patient care. To address these objectives, the investigators and CDC have developed and implemented a web-based patient registry to follow prospectively service allocation and patient outcomes. Funding for the program began in October 2001. All eight funded centers are affiliated with U.S. medical schools. Principal investigators at the centers are hematologists (five adult, two pediatric) or cardiologists. Faculty in obstetrics-gynecology, surgery, and multiple other specialties are integral to the model of care at the centers. Other critical components at the centers are clinical laboratory services, training programs, research networks, and education and outreach programs. From August 2003 to March 2006, over 2,600 patients were enrolled in the registry, accounting for a total of more than 5,000 visits to the centers. Immediate goals of the data collection at the centers are to characterize patients receiving care at centers and document the state of health services provided. Long-term goals are to evaluate prospectively clinical outcomes for patients receiving multidisciplinary care and prevention services at centers. The network of data collection across centers will facilitate future collaborative clinical and epidemiologic investigations and enhance collective expertise in hemostasis and coagulation disorders.
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Affiliation(s)
- N F Dowling
- Division of Hereditary Blood Disorders, National Center on Birth Defects and Developmental Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Imbach P, Kühne T, Müller D, Berchtold W, Zimmerman S, Elalfy M, Buchanan GR. Childhood ITP: 12 months follow-up data from the prospective registry I of the Intercontinental Childhood ITP Study Group (ICIS). Pediatr Blood Cancer 2006; 46:351-6. [PMID: 16086422 DOI: 10.1002/pbc.20453] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute and chronic idiopathic thrombocytopenic purpura (ITP) is traditionally based on the duration of thrombocytopenia at the cut-off point of 6 months after diagnosis. Registry I evaluated the diagnosis, definition, management, and follow-up of childhood ITP. This report focuses on children with thrombocytopenia persisting more than 6 months. PROCEDURE Data were collected by questionnaires to the physicians caring for children with ITP, at diagnosis, 6, and 12 months later. Data were compared regarding initial features and follow-up with emphasis on children with persistent thrombocytopenia, and those with ITP who recovered their platelet counts between 7 and 12 months from diagnosis. RESULTS At 12 months from diagnosis, 79 of 308 (25.6%) evaluable children recovered from ITP and 229 had ongoing ITP. Children with recovered ITP were younger than children with ongoing ITP (P = 0.043) and exhibited a lower frequency of bleeding symptoms during the first 6 months after diagnosis (P = 0.018). Frequency of hospitalization, bone marrow aspiration, and drug treatment differed regionally. CONCLUSIONS The high rate of recovery from ITP between 7 to 12 months demonstrates, that the cut-off point of 6 months for the definition of chronic ITP does not adequately differentiate chronic from acute ITP. The majority of children with ITP have variable time to recovery with gradual improvement of platelet counts and disappearance of bleeding signs. ITP is a heterogeneous disorder with a diverse natural history and diverse pattern of treatment response.
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Affiliation(s)
- P Imbach
- University Children's Hospital Basel UKBB, Basel, Switzerland.
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Magaziner J, Wehren L, Hawkes WG, Orwig D, Hebel JR, Fredman L, Stone K, Zimmerman S, Hochberg MC. Women with hip fracture have a greater rate of decline in bone mineral density than expected: another significant consequence of a common geriatric problem. Osteoporos Int 2006; 17:971-7. [PMID: 16601918 DOI: 10.1007/s00198-006-0092-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 02/10/2006] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Hip fracture is a major public health problem, annually affecting over 350,000 persons in the United States and 1.6 million worldwide. Consequences include decreased survival, loss of independence, and increased risk of subsequent fractures. A substantial decline in bone mineral density (BMD) also occurs, yet the magnitude of the decline specifically attributable to hip fracture has not been documented. METHODS To determine the amount of BMD decline attributable to hip fracture, the rate of decline in BMD in a cohort of hip fracture patients was compared with that in a cohort of women of similar age and BMD but without hip fracture. All subjects were community dwelling when enrolled. Hip fracture patients in the Baltimore Hip Studies (BHS) came from two hospitals in Baltimore, Maryland, from 1992 through 1995; comparison subjects came from the Study of Osteoporotic Fracture (SOF) enrolled in four areas of the United States during the same period. Eighty-four white, female hip fracture patients 65 years and older from the BHS were compared with 168 SOF participants matched on age, race, and BMD at baseline. BMD of the femoral neck and total hip was measured by dual-energy x-ray absorptiometry. RESULTS Hip fracture patients had a greater decline in BMD during the 12-month postfracture follow-up than that expected on the basis of the nonfracture cohort: 4.9% vs. 0.4% at the femoral neck and 3.5% vs. 0.7% for the total hip. The decline in BMD in hip fracture patients was 11.8 times the amount expected at the femoral neck (matched on age and baseline BMD and adjusted for between-cohort differences in smoking prevalence) and 4.9 times that expected for the total hip at the end of 1 year after the hip fracture. CONCLUSION In this sample of older women, bone loss over the year following hip fracture far exceeded that expected and is an important clinical management concern.
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Affiliation(s)
- J Magaziner
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 W. Redwood Street, Suite 200, Baltimore, MD, 21201, USA.
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Hawkes WG, Williams GR, Zimmerman S, Lapuerta P, Li T, Orwig D, Wehren L, Hebel JR, Magaziner J. A clinically meaningful difference was generated for a performance measure of recovery from hip fracture. J Clin Epidemiol 2005; 57:1019-24. [PMID: 15528052 DOI: 10.1016/j.jclinepi.2004.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The Lower Extremity Gain Scale (LEGS) is a performance measure of tasks that are often impaired in hip fracture patients. This study was designed to determine a clinically meaningful difference in LEGS. METHODS The population was 139 female patients (age >65 years) admitted to Baltimore hospitals. Recovery levels were estimated by fitting trajectory curves for the cohort for the 12 months post fracture. The clinically meaningful difference was evaluated using an anchor-based approach, examining the relationship between the LEGS recovery level and age. A second, distribution-based method used an effect size of .20. RESULTS According to our model, a difference of 5 years in age corresponded to a difference of 1.6-3.6 points in LEGS scores. The standard deviation for LEGS at 12 months was 8.0; thus, Cohen's effect size of 0.2 would equate to a difference of 1.6 points. CONCLUSION This suggests that a clinically meaningful difference in the LEGS scores for a population in this age range would be 2-3 points.
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Affiliation(s)
- W G Hawkes
- Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, MD 21201, USA.
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Shetty B, Campanella L, Thomas T, Fedorchuk M, Davidson T, Michelson L, Volz H, Zimmerman S, Belair E, Truant A. Additions and Corrections - Synthesis and Activity of Some 3-Aryl- and 3-Aralkyl-1,2,3,4-tetrahydro-4-oxo-6-quinazolinesulfonamides. J Med Chem 2004. [DOI: 10.1021/jm00294a603] [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: 11/30/2022]
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Junker K, Koehl U, Zimmerman S, Stein S, Schwabe D, Klingebiel T, Grez M. Kinetics of cell death in T lymphocytes genetically modified with two novel suicide fusion genes. Gene Ther 2003; 10:1189-97. [PMID: 12833128 DOI: 10.1038/sj.gt.3301977] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Donor lymphocyte infusions (DLI) following allogeneic stem cell transplantation are known to mediate graft-versus-leukemia effect (GVL). A major side effect of these immunotherapies is the development of graft-versus-host diseases (GVHD). One promising approach to prevent GVHD is to genetically modify donor T cells with a suicide mechanism that can be induced in the case of GVHD. Here we report on a retroviral vector containing the death effector domain (DED) of the human Fas-associated protein with death domain (FADD). The DED was fused to two copies of an FKBP506-binding protein and a truncated version of the human low-affinity receptor for nerve growth factor (LNGFR). Activation of the death signal pathway can be triggered upon the addition of chemical inducers of dimerization. This construct was functionally compared to an optimized HSV-TK vector in which a hypersensitive mutant of the herpes simplex virus thymidine kinase gene (TK39) was fused to a cytoplasmic truncated version of the cell surface antigen CD34. A direct comparison between both vectors in primary T lymphocytes showed that the number of T cells transduced with vectors containing the DED was significantly reduced within 24 h of drug administration whereas ganciclovir treatment of TK39-transduced T cells showed a delay in cell death of approximately 3-4 days. Our results indicate that constructs containing the DED may prove to be the most efficient mechanism to quickly eliminate alloreactive T cells.
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Affiliation(s)
- K Junker
- Department of Pediatric Hematology and Oncology, University Hospital, Johann-Wolfgang von Goethe University, Frankfurt, Germany
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Phillips RKS, Wallace MH, Lynch PM, Hawk E, Gordon GB, Saunders BP, Wakabayashi N, Shen Y, Zimmerman S, Godio L, Rodrigues-Bigas M, Su LK, Sherman J, Kelloff G, Levin B, Steinbach G. A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis. Gut 2002; 50:857-60. [PMID: 12010890 PMCID: PMC1773237 DOI: 10.1136/gut.50.6.857] [Citation(s) in RCA: 270] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Non-selective cyclooxygenase (COX) inhibitors (non-steroidal anti-inflammatory drugs) inhibit large bowel carcinogenesis in patients with familial adenomatous polyposis (FAP). Their role in the duodenum of these patients is less certain. The disease modifying activity of specific COX-2 inhibitors has not been explored in humans. PATIENTS AND METHODS This was a randomised, double blind, placebo controlled study of celecoxib (100 mg twice daily (n=34) or 400 mg twice daily (n=32)) versus placebo (n=17), given orally twice daily for six months to patients with FAP. Efficacy was assessed qualitatively by blinded review of shuffled endoscopy videotapes comparing the extent of duodenal polyposis at entry and at six months and quantitatively by measurement of the percentage change in duodenal area covered by discrete and plaque-like adenomas from photographs of high and low density polyposis. RESULTS Shuffled and blinded video review showed a statistically significant effect of 400 mg twice daily celecoxib compared with placebo treatment (p=0.033) with all five independent observers scoring a beneficial effect. Overall, patients taking celecoxib 400 mg twice daily showed a 14.5% reduction in involved areas compared with a 1.4% for placebo (p=0.436). However, patients with clinically significant disease at baseline (greater than 5% covered by polyps) showed a 31% reduction in involved areas with celecoxib 400 mg twice daily compared with 8% on placebo (p=0.049). CONCLUSIONS A panel of five endoscopists found a significant reduction in duodenal polyposis after six months of treatment with celecoxib 400 mg twice daily. COX-2 inhibition may help this otherwise untreatable condition.
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Affiliation(s)
- R K S Phillips
- Colorectal Cancer Unit, Imperial Cancer Research Fund, London, UK
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