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Abstract
Polycystic ovary syndrome (PCOS), characterized by abnormal menstrual periods, elevated androgen levels and polycystic ovary morphology on ultrasound, is the most common endocrine disorder among females. PCOS is associated with cardiovascular disease (CVD) risk factors including diabetes, obesity, metabolic syndrome, adverse pregnancy outcomes such as pre-eclampsia and psychosocial distress including depression. Previous evidence on the association between PCOS and CVD is inconclusive but the latest 2023 International Evidence-Based PCOS Guideline identifies PCOS as a risk factor for CVD. This review will discuss the relationship between PCOS and CVD along with current direction for CVD screening and prevention among individuals with PCOS.
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Affiliation(s)
- J L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Goldberg
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - C T Tay
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Jennison T, MacGregor A, Goldberg A. Hip arthroplasty practice across the Organisation for Economic Co-operation and Development (OECD) over the last decade. Ann R Coll Surg Engl 2023; 105:645-652. [PMID: 37652085 PMCID: PMC10471436 DOI: 10.1308/rcsann.2022.0101] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION There are large variations in the number of hip replacements performed between countries, demonstrating large health inequalities; however, there has been limited research on this variation. The aims of this paper were to compare rates of hip replacements using Organisation for Economic Co-operation and Development (OECD) data for the period 2008-2018. The study also compared changes in the number of hip replacements in the total population and in only those aged over 65, and looked for a correlation of health expenditure and gross domestic product (GDP) with rates of hip replacements. METHODS The OECD collects annual data from all member countries on the numbers of hip replacements, healthcare expenditure and GDP. Data analysis was undertaken using STATA. Descriptive statistics and Pearson's correlation coefficient were performed. RESULTS The mean number of hip replacements performed in OECD countries in 2018 was 191.5 per 100,000 population per year. The largest number was 310.6 in Germany and the lowest was 8.6 in Mexico. There has been a 21.7% increase in the mean number of hip replacements across OECD countries. There was a moderate and significant Pearson coefficient of 0.468 (p = 0.009) between the number of hip replacements performed per 100,000 population in 2018 and GDP per person, and a strong and significant correlation with health expenditure (R = 0.784, p < 0.001). There was a moderate correlation (R = 0.645, p = 0.003) between the percentage change in the number of hip replacements performed per 100,000 population and the percentage change in healthcare expenditure per person between 2008 and 2018. CONCLUSIONS There is 36-fold variation in the practice of hip replacements across the OECD and the number of hip replacements has increased by more than 20% over the past decade. The number of hip replacements performed appears to be correlated with health expenditure in each country and may indicate a need that can only be met by increasing health expenditure.
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Affiliation(s)
- T Jennison
- Cardiff and Vale University Health Board, UK
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Waissengrin B, Zahavi T, Salmon-Divon M, Goldberg A, Wolf I, Rubinek T, Winkler T, Farkash O, Grinshpun A, Zubkov A, Khatib M, Shachar S, Keren N, Carmi-Levy I, Ben-David U, Sonnenblick A. The effect of non-oncology drugs on clinical and genomic risk in early luminal breast cancer. ESMO Open 2022; 7:100648. [PMID: 36462463 PMCID: PMC9808449 DOI: 10.1016/j.esmoop.2022.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND An effect of non-oncology medications on cancer outcome has been proposed. In this study, we aimed to systematically examine the impact of commonly prescribed non-oncology drugs on clinical risk and on the genomic risk [based on the Oncotype DX recurrence score (RS)] in early breast cancer (BC). EXPERIMENTAL DESIGN We collected data on clinical risk (stage and grade), genomic risk (Oncotype DX RS), and on non-oncology medications administered to 1423 patients with estrogen receptor-positive human epidermal growth factor receptor 2-negative BC during the month of their surgery. The influence of various medications on clinical and genomic risks was evaluated by statistical analysis. RESULTS Out of the multiple drugs we examined, levothyroxine was significantly associated with a high Oncotype DX RS (mean 24.78; P < 0.0001) and metformin with a low Oncotype DX RS (mean 14.87; P < 0.01) compared with patients not receiving other non-oncology drugs (mean 18.7). By contrast, there were no differences in the clinical risk between patients receiving metformin, levothyroxine, or no other non-oncology drugs. Notably, there was no association between the consumption of levothyroxine and metformin and proliferation marker (Ki67) levels, but both drugs were significantly associated with progesterone-related features, suggesting that they influence genomic risk through estrogen-dependent signaling. CONCLUSIONS The results of this study indicate a significant impact of metformin and levothyroxine on clinical decisions in luminal BC, with potential impact on the clinical course of these patients.
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Affiliation(s)
- B. Waissengrin
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - T. Zahavi
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel
| | - M. Salmon-Divon
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel
| | - A. Goldberg
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel
| | - I. Wolf
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - T. Rubinek
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - T. Winkler
- Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O. Farkash
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv
| | - A. Grinshpun
- Breast Oncology Center, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - A. Zubkov
- Pathology Department, Pathology Institute, Tel Aviv Medical Center, Tel Aviv
| | - M. Khatib
- Division of General Surgery, Tel Aviv Medical Center, Tel Aviv
| | - S.S. Shachar
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - N. Keren
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | | | - U. Ben-David
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - A. Sonnenblick
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv,Sackler School of Medicine, Tel Aviv University, Tel Aviv,Correspondence to: Dr Amir Sonnenblik, MD, Tel Aviv Sourasky Medical Center, 6 Waizman Street, Tel Aviv 64239, Israel; Tel: +972-3-6972446
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Wiberg-Itzel E, Sterpu I, Goldberg A, Patavoukas E, Hertting E. 112 Are there different forms of dystocia? should they be treated differently in clinical practice? Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.211] [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: 11/04/2022]
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Anthony S, Young K, Pol S, Blydt-Hansen T, Goldberg A, Hamiwka L, Urschel S, Santana M, Stinson J, West L. Improving the Care for Pediatric Transplant Patients through Integration of Patient-Reported Outcome Measures into Clinical Practice. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Braaten K, Janiak E, Fulcher I, Cotrill A, Fortin J, Goldberg A. Surgical abortion in patients with opioid dependence: Disparities in demographic factors, procedural pain, and post-abortion contraception. Contraception 2019. [DOI: 10.1016/j.contraception.2019.03.004] [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: 10/26/2022]
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Goldberg A, Lokireddy S, Kim H, Kuo C, VerPlank J. NEW INSIGHTS INTO THE PROTEASOME FUNCTION AND DEGRADATION OF MISFOLDED PROTEINS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Goldberg
- Department of Cell Biology Harvard Medical School, Boston, Massachusetts, United States
| | - S Lokireddy
- Oncosimis Biotech Private Limited, Hyderabad, India
| | - H Kim
- Department of Cell Biology, Harvard Medical School, Boston, MA, USA
| | - C Kuo
- Department of Cell Biology, Harvard Medical School, Boston, MA, USA
| | - J VerPlank
- Department of Cell Biology, Harvard Medical School, Boston, MA, USA
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Mastey N, Roe A, Maurer R, Goldberg A. Postabortion long-acting reversible contraceptive uptake among opioid-dependent patients. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gourh P, Remmers EF, Boyden SE, Alexander T, Morgan ND, Shah AA, Mayes MD, Doumatey A, Bentley AR, Shriner D, Domsic RT, Medsger TA, Steen VD, Ramos PS, Silver RM, Korman B, Varga J, Schiopu E, Khanna D, Hsu V, Gordon JK, Saketkoo LA, Gladue H, Kron B, Criswell LA, Derk CT, Bridges SL, Shanmugam VK, Kolstad KD, Chung L, Jan R, Bernstein EJ, Goldberg A, Trojanowski M, Kafaja S, Maksimowicz-McKinnon KM, Mullikin JC, Adeyemo A, Rotimi C, Boin F, Kastner DL, Wigley FM. Brief Report: Whole-Exome Sequencing to Identify Rare Variants and Gene Networks That Increase Susceptibility to Scleroderma in African Americans. Arthritis Rheumatol 2018; 70:1654-1660. [PMID: 29732714 DOI: 10.1002/art.40541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/26/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Whole-exome sequencing (WES) studies in systemic sclerosis (SSc) patients of European American (EA) ancestry have identified variants in the ATP8B4 gene and enrichment of variants in genes in the extracellular matrix (ECM)-related pathway that increase SSc susceptibility. This study was undertaken to evaluate the association of the ATP8B4 gene and the ECM-related pathway with SSc in a cohort of African American (AA) patients. METHODS SSc patients of AA ancestry were enrolled from 23 academic centers across the US under the Genome Research in African American Scleroderma Patients consortium. Unrelated AA individuals without serologic evidence of autoimmunity who were enrolled in the Howard University Family Study were used as unaffected controls. Functional variants in genes reported in the 2 WES studies in EA patients with SSc were selected for gene association testing using the optimized sequence kernel association test (SKAT-O) and pathway analysis by Ingenuity Pathway Analysis in 379 patients and 411 controls. RESULTS Principal components analysis demonstrated that the patients and controls had similar ancestral backgrounds, with roughly equal proportions of mean European admixture. Using SKAT-O, we examined the association of individual genes that were previously reported in EA patients and none remained significant, including ATP8B4 (P = 0.98). However, we confirmed the previously reported association of the ECM-related pathway with enrichment of variants within the COL13A1, COL18A1, COL22A1, COL4A3, COL4A4, COL5A2, PROK1, and SERPINE1 genes (corrected P = 1.95 × 10-4 ). CONCLUSION In the largest genetic study in AA patients with SSc to date, our findings corroborate the role of functional variants that aggregate in a fibrotic pathway and increase SSc susceptibility.
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Affiliation(s)
- Pravitt Gourh
- NIAMS and National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Elaine F Remmers
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Steven E Boyden
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | - Nadia D Morgan
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ayo Doumatey
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Amy R Bentley
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Daniel Shriner
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | | | | | | | | | - Benjamin Korman
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - John Varga
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Vivien Hsu
- Robert Wood Johnson University, New Brunswick, New Jersey
| | | | | | - Heather Gladue
- Arthritis and Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina
| | | | | | | | | | | | | | - Lorinda Chung
- Stanford University School of Medicine, Stanford, California, and Palo Alto VA Health Care System, Palo Alto, California
| | - Reem Jan
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Elana J Bernstein
- New York Presbyterian Hospital, Columbia University, New York, New York
| | - Avram Goldberg
- New York University Langone Medical Center, New York, New York
| | | | - Suzanne Kafaja
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - James C Mullikin
- National Human Genome Research Institute, NIH Intramural Sequencing Center, Rockville, Maryland
| | | | - Charles Rotimi
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | - Daniel L Kastner
- National Human Genome Research Institute, NIH, Bethesda, Maryland
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Welck MJ, Singh D, Cullen N, Goldberg A. Evaluation of the 1st metatarso-sesamoid joint using standing CT - The Stanmore classification. Foot Ankle Surg 2018; 24:314-319. [PMID: 29409245 DOI: 10.1016/j.fas.2017.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/08/2017] [Accepted: 03/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Little is understood about the role that relative sesamoid displacement and chondral wear have on outcome after hallux valgus (HV) surgery. All existing methods to evaluate relative sesamoid displacement have limitations and furthermore, there have been no radiographic studies evaluating metatarso-sesamoid joint wear. Standing CT scan circumvents many of the existing problems in evaluation of relative sesamoid displacement, and also enables the first radiographic study assessing metatarso-sesamoid joint wear. METHODS Fifty feet (in 43 patients) with symptomatic HV (Group A) were compared with a control group of 50 feet (50 patients) (Group B). All images were standardised to enable reproducible measurements. The hallux valgus angle, Intermetatarsal angle, sesamoid rotation angle, sesamoid position and metatarso-sesamoid joint space were measured in all patients. RESULTS The intra and inter-observer reliability correlation showed that the standing CT assessment of sesamoid position (1.000), rotation (0.991) and metatarso-sesamoid joint space (0.960) were highly reproducible. There was a highly significant difference (p<0.0001) in sesamoid position, sesamoid rotation and metatarso-sesamoid joint space between Group A and Group B. CONCLUSIONS Standing CT has been shown to be a reproducible and accurate method of assessing the relative sesamoid displacement and metatarso-sesamoid joint space narrowing. The results have been used to propose a novel standing CT based classification of hallucal sesamoids, considering the degree of displacement and wear. This classification may ultimately facilitate research to provide new insight into the effect relative sesamoid displacement and chondral wear have on outcomes from hallux valgus surgery.
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Affiliation(s)
- M J Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.
| | - D Singh
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - N Cullen
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - A Goldberg
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
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DeMaria S, Berman DJ, Goldberg A, Lin HM, Khelemsky Y, Levine AI. Team-based model for non-operating room airway management: validation using a simulation-based study. Br J Anaesth 2018; 117:103-8. [PMID: 27317709 DOI: 10.1093/bja/aew121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Non-operating room (non-OR) airway management has previously been identified as an area of concern because it carries a significant risk for complications. One reason for this could be attributed to the independent practice of residents in these situations. The aim of the present study was to ascertain whether differences in performance exist between residents working alone vs with a resident partner when encountering simulated non-OR airway management scenarios. METHODS Thirty-six anaesthesia residents were randomized into two groups. Each group experienced three separate scenarios (two scenarios initially and then a third 6 weeks later). The scenarios consisted of one control scenario and two critical event scenarios [i.e. asystole during laryngoscopy and pulseless electrical activity (PEA) upon post-intubation institution of positive pressure ventilation]. One group experienced the simulated non-OR scenarios alone (Solo group). The other group consisted of resident pairs, participating in the same three scenarios (Team group). RESULTS Although the time to intubation did not differ between the Solo and Team groups, there were several differences in performance. The Team group received better overall performance ratings for the asystole (8.5 vs 5.5 out of 10; P<0.001) and PEA (8.5 vs 5.8 out of 10; P<0.001) scenarios. The Team group was also able to recognize asystole and PEA conditions faster than the Solo group [10.1 vs 23.5 s (P<0.001) and 13.3 vs 36.0 s (P<0.001), respectively]. CONCLUSIONS Residents who performed a simulated intubation with a second trained provider had better overall performance than those who practised independently. The residents who practised in a group were also faster to diagnose serious complications, including peri-intubation asystole and PEA. Given these data, it is reasonable that training programmes consider performing all non-OR airway management with a team-based method.
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Affiliation(s)
- S DeMaria
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - D J Berman
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - A Goldberg
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - H-M Lin
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - Y Khelemsky
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - A I Levine
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA
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Morgan ND, Shah AA, Mayes MD, Domsic RT, Medsger TA, Steen VD, Varga J, Carns M, Ramos PS, Silver RM, Schiopu E, Khanna D, Hsu V, Gordon JK, Gladue H, Saketkoo LA, Criswell LA, Derk CT, Trojanowski MA, Shanmugam VK, Chung L, Valenzuela A, Jan R, Goldberg A, Remmers EF, Kastner DL, Wigley FM, Gourh P, Boin F. Clinical and serological features of systemic sclerosis in a multicenter African American cohort: Analysis of the genome research in African American scleroderma patients clinical database. Medicine (Baltimore) 2017; 96:e8980. [PMID: 29390428 PMCID: PMC5758130 DOI: 10.1097/md.0000000000008980] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Racial differences exist in the severity of systemic sclerosis (SSc). To enhance our knowledge about SSc in African Americans, we established a comprehensive clinical database from the largest multicenter cohort of African American SSc patients assembled to date (the Genome Research in African American Scleroderma Patients (GRASP) cohort).African American SSc patients were enrolled retrospectively and prospectively over a 30-year period (1987-2016), from 18 academic centers throughout the United States. The cross-sectional prevalence of sociodemographic, clinical, and serological features was evaluated. Factors associated with clinically significant manifestations of SSc were assessed using multivariate logistic regression analyses.The study population included a total of 1009 African American SSc patients, comprised of 84% women. In total, 945 (94%) patients met the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc, with the remaining 64 (6%) meeting the 1980 ACR or CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia) criteria. While 43% were actively employed, 33% required disability support. The majority (57%) had the more severe diffuse subtype and a young age at symptom onset (39.1 ± 13.7 years), in marked contrast to that reported in cohorts of predominantly European ancestry. Also, 1 in 10 patients had a severe Medsger cardiac score of 4. Pulmonary fibrosis evident on computed tomography (CT) chest was present in 43% of patients and was significantly associated with anti-topoisomerase I positivity. 38% of patients with CT evidence of pulmonary fibrosis had a severe restrictive ventilator defect, forced vital capacity (FVC) ≤50% predicted. A significant association was noted between longer disease duration and higher odds of pulmonary hypertension, telangiectasia, and calcinosis. The prevalence of potentially fatal scleroderma renal crisis was 7%, 3.5 times higher than the 2% prevalence reported in the European League Against Rheumatism Scleroderma Trials and Research (EUSTAR) cohort.Our study emphasizes the unique and severe disease burden of SSc in African Americans compared to those of European ancestry.
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Affiliation(s)
- Nadia D. Morgan
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ami A. Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maureen D. Mayes
- Division of Rheumatology, University of Texas-McGovern Medical School, Houston, TX
| | | | | | - Virginia D. Steen
- Division of Rheumatology, Georgetown University School of Medicine, Washington, DC
| | - John Varga
- Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Mary Carns
- Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Paula S. Ramos
- Division of Rheumatology, Medical University of South Carolina, Charleston, SC
| | - Richard M. Silver
- Division of Rheumatology, Medical University of South Carolina, Charleston, SC
| | - Elena Schiopu
- Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Vivien Hsu
- Division of Rheumatology, Robert Wood Johnson University, New Brunswick, NJ
| | - Jessica K. Gordon
- Division of Rheumatology, Hospital for Special Surgery, New York, NY
| | - Heather Gladue
- Department of Rheumatology, Arthritis and Osteoporosis Consultants of the Carolinas, Charlotte, NC
| | - Lesley A. Saketkoo
- Division of Rheumatology, Tulane University School of Medicine, New Orleans, LA
| | | | - Chris T. Derk
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Lorinda Chung
- Division of Rheumatology, Stanford University School of Medicine, Stanford, CA
| | - Antonia Valenzuela
- Division of Rheumatology, Stanford University School of Medicine, Stanford, CA
| | - Reem Jan
- Division of Rheumatology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Avram Goldberg
- Division of Rheumatology, New York University Langone Medical Center, New York, NY
| | | | | | - Fredrick M. Wigley
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pravitt Gourh
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Francesco Boin
- Division of Rheumatology, University of California San Francisco, CA
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Bromiker R, Goldberg A, Kaplan M. Israel transcutaneous bilirubin nomogram predicts significant hyperbilirubinemia. J Perinatol 2017; 37:1315-1318. [PMID: 29192695 DOI: 10.1038/jp.2017.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/10/2017] [Accepted: 07/05/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We constructed a transcutaneous bilirubin (TcB) nomogram to represent major sectors of the Israeli population. We studied the risk of hyperbilirubinemia, defined as meeting the requirements for phototherapy, per percentile risk category. STUDY DESIGN Newborns ⩾36 weeks gestation were tested daily for TcB, using Drager JM-103 devices, during birth hospitalization. A nomogram was constructed and divided into four risk groups and validated by calculating the need for phototherapy for each group. RESULTS A total of 3303 measurements were performed on 1059 consecutive newborns including Ashkenazi, Sephardic and mixed Ashkenazi/Sephardic Jews, Arab and Ethiopian Jewish. Phototherapy risk increased progressively and more than 100-fold, from 0/225 in the <40th percentile group through 27/120 (22.5%) for those >95th percentile (relative risk (95% confidence interval) 102 (6 to 1669) for those >95th percentile compared with those <40th percentile). The optimal risk for discriminating the need for phototherapy was >75th percentile (sensitivity 93.33, specificity 59.47). CONCLUSION The risk of significant hyperbilirubinemia increased progressively with increasing percentile. Newborns >75th percentile groups are at high risk for phototherapy and should be closely monitored.
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Affiliation(s)
- R Bromiker
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - A Goldberg
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - M Kaplan
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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Shuler K, Sucic J, Talley S, Goldberg A. STEPPING PERFORMANCE IN OLDER ADULTS: ASSOCIATION WITH THE ACE GENE INSERTION/DELETION POLYMORPHISM. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.700] [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)
- K. Shuler
- University of Michigan-Flint, Flint, Michigan
| | - J.F. Sucic
- University of Michigan-Flint, Flint, Michigan
| | - S.A. Talley
- University of Michigan-Flint, Flint, Michigan
| | - A. Goldberg
- University of Michigan-Flint, Flint, Michigan
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Hunter S, Katz D, Goldberg A, Lin HM, Pasricha R, Benesh G, Le Grand B, DeMaria S. Use of an anaesthesia workstation barrier device to decrease contamination in a simulated operating room. Br J Anaesth 2017; 118:870-875. [DOI: 10.1093/bja/aex097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/12/2022] Open
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Wiebe C, Gareau AJ, Pochinco D, Gibson IW, Ho J, Birk PE, Blydt-Hansen T, Karpinski M, Goldberg A, Storsley L, Rush DN, Nickerson PW. Evaluation of C1q Status and Titer of De Novo Donor-Specific Antibodies as Predictors of Allograft Survival. Am J Transplant 2017; 17:703-711. [PMID: 27539748 DOI: 10.1111/ajt.14015] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/09/2016] [Accepted: 08/13/2016] [Indexed: 01/25/2023]
Abstract
De novo donor-specific antibodies (dnDSAs) that develop after renal transplantation are independent predictors of allograft loss. However, it is unknown if dnDSA C1q status or titer at the time of first detection can independently predict allograft loss. In a consecutive cohort of 508 renal transplant recipients, 70 developed dnDSAs. Histologic and clinical outcomes were correlated with the C1q assay or dnDSA titer. C1q positivity correlated with dnDSA titer (p < 0.01) and mean fluorescence intensity (p < 0.01) and was more common in class II versus class I dnDSAs (p < 0.01). C1q status correlated with tubulitis (p = 0.02) and C4d status (p = 0.03) in biopsies at the time of dnDSA development, but not T cell-mediated rejection (TCMR) or antibody-mediated rejection (ABMR). De novo DSA titer correlated with Banff g, i, t, ptc, C4d scores, TCMR (p < 0.01) and ABMR (p < 0.01). Post-dnDSA graft loss was observed more frequently in recipients with C1q-positve dnDSA (p < 0.01) or dnDSA titer ≥ 1:1024 (p ≤ 0.01). However, after adjustment for clinical phenotype and nonadherence in multivariate models, neither C1q status nor dnDSA titer were independently associated with allograft loss, questioning the utility of these assays at the time of dnDSA development.
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Affiliation(s)
- C Wiebe
- Department of Medicine, University of Manitoba, Winnipeg, Canada.,Diagnostic Services of Manitoba, Winnipeg, Canada
| | - A J Gareau
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - D Pochinco
- Diagnostic Services of Manitoba, Winnipeg, Canada
| | - I W Gibson
- Diagnostic Services of Manitoba, Winnipeg, Canada.,Department of Pathology, University of Manitoba, Winnipeg, Canada
| | - J Ho
- Department of Medicine, University of Manitoba, Winnipeg, Canada.,Department of Immunology, University of Manitoba, Winnipeg, Canada
| | - P E Birk
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - T Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - M Karpinski
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - A Goldberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - L Storsley
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - D N Rush
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - P W Nickerson
- Department of Medicine, University of Manitoba, Winnipeg, Canada.,Diagnostic Services of Manitoba, Winnipeg, Canada.,Department of Immunology, University of Manitoba, Winnipeg, Canada
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Ely K, Stafflinger J, Goldberg A. Efficacy of the Routine Postoperative Visit in Benign Gynecologic Ambulatory Procedures. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.589] [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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Pocius K, Bartz D, Maurer R, Stenquist A, Fortin J, Goldberg A. Serum human chorionic gonadotropin (hCG) trend within the first few days after medication abortion: a prospective study. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.048] [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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22
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Horwitz G, Roncari D, Braaten K, Maurer R, Fortin J, Goldberg A. BMI as predictor of adverse outcomes with moderate intravenous sedation during surgical abortion. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ngo L, Braaten K, Eichen E, Fortin J, Maurer R, Goldberg A. Naproxen sodium for pain control with intrauterine device insertion: a randomized controlled trial. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.083] [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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Affiliation(s)
- A Goldberg
- University Department of Medicine, Gardiner Institute, Western Infirmary, Glasgow
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Dunleavy K, Kava K, Goldberg A, Malek M, Talley S, Tutag-Lehr V, Hildreth J. Comparative effectiveness of Pilates and yoga group exercise interventions for chronic mechanical neck pain: quasi-randomised parallel controlled study. Physiotherapy 2016; 102:236-42. [DOI: 10.1016/j.physio.2015.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
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Harfouche M, Maher Z, Krowsoski L, Goldberg A. Global surgical electives in residency: the impact on training and future
practice at Temple University Hospital. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.172] [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] Open
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Affiliation(s)
- M. R. Moore
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
| | - A. Goldberg
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
| | - W. M. Fyfe
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
| | - R. A. Low
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
| | - W. N. Richards
- University Department of Medicine, Western Infirmary Divisions of Paediatrics and Obstetrics and Gynaecology, Stobhill General Hospital and Strathclyde Water Department, Balmore Road, Glasgow
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Abstract
It has been shown that there is a high incidence of latent iron deficiency (sideropenia) in the female population. To assess the role of this deficiency as a cause of symptoms a double blind trial of iron and placebo therapy was carried out on 20 sideropenic women presenting with symptoms. The incidence of all the symptoms studied fell and there was no significant difference between iron and placebo in producing improvement. A significant rise in haemoglobin level occurred only in response to iron therapy and this was reversed on cessation of iron. No significant changes in haemoglobin occurred in response to the placebo. It has been concluded that while iron has no specific effect on the symptoms associated with sideropenia, it will produce a significant rise in haemoglobin level, reverse biochemical defects and, in a minority, prevent development of iron deficiency anaemia.
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Affiliation(s)
- J. J. Morrow
- University Department of Medicine, Gardiner Institute, Western Infirmary, Glasgow
| | - J. H. Dagg
- University Department of Medicine, Gardiner Institute, Western Infirmary, Glasgow
| | - A. Goldberg
- University Department of Medicine, Gardiner Institute, Western Infirmary, Glasgow
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Affiliation(s)
- F. B. McGillion
- University Department of Materia Medica, Stobhill General Hospital, Glasgow
| | - M. R. Moore
- University Department of Materia Medica, Stobhill General Hospital, Glasgow
| | - A. Goldberg
- University Department of Materia Medica, Stobhill General Hospital, Glasgow
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Affiliation(s)
- A. Goldberg
- University Department of Medicine, Western Infirmary, Glasgow
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Shah AA, Schiopu E, Chatterjee S, Csuka ME, Frech T, Goldberg A, Spiera R, Peng SL, McBride RJ, Cleveland JM, Steen V. The Recurrence of Digital Ulcers in Patients with Systemic Sclerosis after Discontinuation of Oral Treprostinil. J Rheumatol 2016; 43:1665-71. [PMID: 27307535 DOI: 10.3899/jrheum.151437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Prior studies investigating the efficacy of oral treprostinil to treat digital ulcers (DU) in systemic sclerosis (SSc)-associated Raynaud phenomenon have yielded conflicting results. In this investigation, we examined whether DU burden increased after patients withdrew from oral treprostinil that was administered during an open-label extension study. METHODS A multicenter, retrospective study was conducted to determine DU burden in the year after withdrawal from oral treprostinil. DU burden 3-6 months (Time A) and > 6-12 months (Time B) after drug withdrawal was compared with DU burden at baseline, defined as the last day receiving drug in the open-label extension study, by a paired Student t test. Changes in DU burden while receiving drug in the open-label study were compared with changes in DU burden at Time B by a paired Student t test. RESULTS Fifty-one patients from 9 clinical sites were included for analysis. DU burden increased significantly from baseline (mean 0.47) to Time A (mean 2.1, p = 0.002, n = 23) and Time B (mean 1.45, p = 0.013, n = 30). Total DU burden decreased during oral treprostinil exposure (mean change -0.6) and then increased by Time B (mean change 1.05, p = 0.0027 for comparison, n = 30). In the year after drug withdrawal, many patients required vasodilator therapy and pain medications. Three patients were hospitalized for complications from DU, and 4 patients required surgery for DU. CONCLUSION Total DU burden increased significantly after discontinuation of oral treprostinil. These data provide supportive evidence of a beneficial effect of oral treprostinil for the vascular complications of SSc and suggest that further study is warranted.
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Affiliation(s)
- Ami A Shah
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University.
| | - Elena Schiopu
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
| | - Soumya Chatterjee
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
| | - Mary Ellen Csuka
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
| | - Tracy Frech
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
| | - Avram Goldberg
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
| | - Robert Spiera
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
| | - Stanford L Peng
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
| | - Ryan J McBride
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
| | - Jody M Cleveland
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
| | - Virginia Steen
- From the Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Michigan, Ann Arbor, Michigan; Cleveland Clinic, Cleveland, Ohio; Medical College of Wisconsin, Milwaukee, Wisconsin; University of Utah, Salt Lake City, Utah; New York University (NYU) Langone Medical Center, Lake Success; Hospital for Special Surgery, New York, New York; Benaroya Research Institute at Virginia Mason, Seattle, Washington; Georgetown University, Washington, DC; University of North Carolina at Chapel Hill, Chapel Hill; United Therapeutics Corporation, Research Triangle Park, North Carolina, USA.A.A. Shah, MD, MHS, Assistant Professor of Medicine, Director of Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine; E. Schiopu, MD, Assistant Professor of Internal Medicine, University of Michigan; S. Chatterjee, MD, Associate Professor of Medicine, Cleveland Clinic; M.E. Csuka, MD, Professor of Medicine, Medical College of Wisconsin; T. Frech, MD, Associate Professor of Medicine, University of Utah; A. Goldberg, MD, Clinical Assistant Professor, NYU Langone Medical Center; R. Spiera, MD, Professor of Clinical Medicine, Hospital for Special Surgery; S.L. Peng, MD, PhD, Vice President, Clinical Development, Benaroya Research Institute at Virginia Mason; R.J. McBride, DrPH, Student, University of North Carolina at Chapel Hill; J.M. Cleveland, MS, Director, Biostatistics, United Therapeutics Corp.; V. Steen, MD, Professor of Medicine, Georgetown University
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Abstract
INTRODUCTION Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade. METHODS Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend. RESULTS The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic. CONCLUSIONS Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study's level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence.
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Affiliation(s)
- A Sharma
- Royal National Orthopaedic Hospital NHS Trust , UK
| | | | - A Carter
- South Warwickshire NHS Foundation Trust , UK
| | - R Zaidi
- Royal National Orthopaedic Hospital NHS Trust , UK
| | - S Cro
- Medical Research Council , UK
| | - T Briggs
- Royal National Orthopaedic Hospital NHS Trust , UK
| | - A Goldberg
- Royal National Orthopaedic Hospital NHS Trust , UK
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Samuelson ST, Burnett G, Sim AJ, Hofer I, Weinberg AD, Goldberg A, Chang TS, DeMaria S. Simulation as a set-up for technical proficiency: can a virtual warm-up improve live fibre-optic intubation? Br J Anaesth 2016; 116:398-404. [PMID: 26821699 DOI: 10.1093/bja/aev436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fibre-optic intubation (FOI) is an advanced technical skill, which anaesthesia residents must frequently perform under pressure. In surgical subspecialties, a virtual 'warm-up' has been used to prime a practitioner's skill set immediately before performance of challenging procedures. This study examined whether a virtual warm-up improved the performance of elective live patient FOI by anaesthesia residents. METHODS Clinical anaesthesia yr 1 and 2 (CA1 and CA2) residents were recruited to perform elective asleep oral FOI. Residents either underwent a 5 min, guided warm-up (using a bronchoscopy simulator) immediately before live FOI on patients with predicted normal airways or performed live FOI on similar patients without the warm-up. Subjects were timed performing FOI (from scope passing teeth to viewing the carina) and were graded on a 45-point skill scale by attending anaesthetists. After a washout period, all subjects were resampled as members of the opposite cohort. Multivariate analysis was performed to control for variations in previous FOI experience of the residents. RESULTS Thirty-three anaesthesia residents were recruited, of whom 22 were CA1 and 11 were CA2. Virtual warm-up conferred a 37% reduction in time for CA1s (mean 35.8 (SD 3.2) s vs. 57 (SD 3.2) s, P<0.0002) and a 26% decrease for CA2s (mean 23 (SD 1.7) s vs. 31 (SD 1.7) s, P=0.0118). Global skill score increased with warm-up by 4.8 points for CA1s (mean 32.8 (SD 1.2) vs. 37.6 (SD 1.2), P=0.0079) and 5.1 points for CA2s (37.7 (SD 1.1) vs. 42.8 (SD 1.1), P=0.0125). Crossover period and sequence did not show a statistically significant association with performance. CONCLUSIONS Virtual warm-up significantly improved performance by residents of FOI in live patients with normal airway anatomy, as measured both by speed and by a scaled evaluation of skills.
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Affiliation(s)
| | | | - A J Sim
- Department of Anesthesiology
| | - I Hofer
- Department of Anesthesiology, UCLA David Geffen School of Medicine, 757 Westwood Plaza #3325, Los Angeles, CA 90024, USA
| | - A D Weinberg
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA, and
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Wiebe C, Gibson IW, Blydt-Hansen TD, Pochinco D, Birk PE, Ho J, Karpinski M, Goldberg A, Storsley L, Rush DN, Nickerson PW. Rates and determinants of progression to graft failure in kidney allograft recipients with de novo donor-specific antibody. Am J Transplant 2015; 15:2921-30. [PMID: 26096305 DOI: 10.1111/ajt.13347] [Citation(s) in RCA: 258] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/13/2015] [Accepted: 04/05/2015] [Indexed: 01/25/2023]
Abstract
Understanding rates and determinants of clinical pathologic progression for recipients with de novo donor-specific antibody (dnDSA), especially subclinical dnDSA, may identify surrogate endpoints and inform clinical trial design. A consecutive cohort of 508 renal transplant recipients (n = 64 with dnDSA) was studied. Recipients (n = 388) without dnDSA or dysfunction had an eGFR decline of -0.65 mL/min/1.73 m(2) /year. In recipients with dnDSA, the rate eGFR decline was significantly increased prior to dnDSA onset (-2.89 vs. -0.65 mL/min/1.73 m(2) /year, p < 0.0001) and accelerated post-dnDSA (-3.63 vs. -2.89 mL/min/1.73 m(2) /year, p < 0.0001), suggesting that dnDSA is both a marker and contributor to ongoing alloimmunity. Time to 50% post-dnDSA graft loss was longer in recipients with subclinical versus a clinical dnDSA phenotype (8.3 vs. 3.3 years, p < 0.0001). Analysis of 1091 allograft biopsies found that dnDSA and time independently predicted chronic glomerulopathy (cg), but not interstitial fibrosis and tubular atrophy (IFTA). Early T cell-mediated rejection, nonadherence, and time were multivariate predictors of IFTA. Independent risk factors for post-dnDSA graft survival available prior to, or at the time of, dnDSA detection were delayed graft function, nonadherence, dnDSA mean fluorescence intensity sum score, tubulitis, and cg. Ultimately, dnDSA is part of a continuum of mixed alloimmune-mediated injury, which requires solutions targeting T and B cells.
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Affiliation(s)
- C Wiebe
- Department of Medicine, University of Manitoba, Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada
| | - I W Gibson
- Department of Pathology, University of Manitoba, Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada
| | - T D Blydt-Hansen
- Department of Pediatrics and Child Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - D Pochinco
- Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada
| | - P E Birk
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J Ho
- Department of Medicine and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M Karpinski
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - A Goldberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - L Storsley
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - D N Rush
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - P W Nickerson
- Departments of Medicine and Immunology, University of Manitoba, Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada
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Raymond E, Weaver M, Tan Y, Louie K, Bousiéguez M, Sanhueza P, Kaplan C, Sonalkar S, Goldberg A, Culwell K, Memmel L, Jamshidi R, Winikoff B. Medical abortion outcomes following quickstart of contraceptive implants and depot-medroxyprogesterone acetate. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.030] [Citation(s) in RCA: 2] [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: 12/01/2022]
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Goldberg A, Silverman E, Samuelson S, Katz D, Lin H, Levine A, DeMaria S. Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice †. Br J Anaesth 2015; 114:794-800. [DOI: 10.1093/bja/aeu457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 11/12/2022] Open
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Kumar M, Johnson L, Goldberg A, Kashiouris M, Keenan L, Rabinstein A. Is selective nasopharyngeal brain cooling detrimental to neuroprotection? Crit Care 2015. [PMCID: PMC4470646 DOI: 10.1186/cc14505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Confino-Cohen R, Brufman I, Goldberg A, Feldman BS. Vitamin D, asthma prevalence and asthma exacerbations: a large adult population-based study. Allergy 2014; 69:1673-80. [PMID: 25139052 DOI: 10.1111/all.12508] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of low vitamin D status on asthma, asthma morbidity and control is unclear. We aimed to investigate in adults the associations between serum 25-hydroxyvitamin D level and prevalent asthma as well as asthma exacerbations. METHODS A cohort of Israeli adults aged 22-50 years with documented vitamin D status were extracted from Clalit Health Services (HMO) between July 1, 2008 and July 1, 2012. Among this population, those with physician-diagnosed asthma and asthma exacerbations were identified. Asthma exacerbations were defined as any of the following: prescription for oral corticosteroids, >5 prescriptions for short acting beta agonists and more than four visits to a physician for asthma. Logistic regression models assessed the associations between vitamin D and both asthma and asthma exacerbations. RESULTS Approximately 308 000 members with at least one vitamin D measurement were included in the cohort. Among them, 6.9% (21 237) had physician-diagnosed asthma vs 5.7% in the general population. Serum 25-OHD levels across both groups were similar. However, among those with vitamin D deficiency, the odds of having an exacerbation were 25% greater compared to those with levels in the normal range. This association remained significant after controlling for known confounders. CONCLUSION While there was no significant association between vitamin D status and physician-diagnosed asthma, there was a strong association with asthma exacerbations. The presented evidence supports vitamin D screening in the subgroup of asthmatics that are uncontrolled and experience recurrent exacerbations.
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Affiliation(s)
- R. Confino-Cohen
- Allergy and Clinical Immunology Unit; Meir Medical Center; Kfar Saba Israel
- Sackler Faculty of Medicine; Tel Aviv University; Israel
| | - I. Brufman
- Clalit Research Institute and Chief Physician Office; Clalit Health Services; Tel Aviv Israel
| | - A. Goldberg
- Allergy and Clinical Immunology Unit; Meir Medical Center; Kfar Saba Israel
- Sackler Faculty of Medicine; Tel Aviv University; Israel
| | - B. S. Feldman
- Clalit Research Institute and Chief Physician Office; Clalit Health Services; Tel Aviv Israel
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Goldberg A, Stauber T, Peleg O, Hanuka P, Eshayek L, Confino-Cohen R. Medical clowns ease anxiety and pain perceived by children undergoing allergy prick skin tests. Allergy 2014; 69:1372-9. [PMID: 24943088 DOI: 10.1111/all.12463] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intervention of medical clowns (MC) during various medical procedures performed in children has been used to relieve anxiety and pain. Their role in allergy skin testing has never been evaluated. OBJECTIVE To evaluate whether MC can diminish pain and anxiety perceived by children undergoing allergy skin prick tests (SPT). METHODS In a prospective, randomized, controlled, and blinded study, children undergoing SPT were or were not accompanied by MC. All parents and children ≥8 years completed the State-Trait Anxiety Inventory (STAI) before and after SPT. Videotapes recorded during the procedure were scored for anxiety (m-YPAS) for all children and for pain (FLACC) for children 2-7 years old by a psychologist who was unaware of the MC's presence. After SPT, children ≥8 years completed a visual analog score (VAS) for pain. RESULTS Ninety-one children (mean age 8.2 years, M/F = 54/37) were recruited of whom 45 were accompanied by clowns. A significant reduction in state-STAI was found in the clowns group, in both parents and children, when compared with the regular group (26.9 ± 6.6 and 32.3 ± 10.0; P = 0.004, and 27.1 ± 4.2 and 34.3 ± 7.6; P = 0.002, respectively). Both m-YPAS and FLACC were reduced in the clowns group compared with the regular one. In the clowns group, m-YPAS positively correlated with both VAS and FLACC (P = 0.000 and 0.002, respectively). m-YPAS was positively correlated with FLACC in the regular group (P = 0.000). CONCLUSION Medical clowns significantly decrease the level of anxiety perceived by both children undergoing allergy SPT and their parents, as well as the pain perceived by young children.
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Affiliation(s)
- A. Goldberg
- The Allergy and Clinical Immunology Unit; Meir Hospital; Kfar-Saba affiliated with The Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - T. Stauber
- The Allergy and Clinical Immunology Unit; Meir Hospital; Kfar-Saba affiliated with The Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - O. Peleg
- The Allergy and Clinical Immunology Unit; Meir Hospital; Kfar-Saba affiliated with The Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - P. Hanuka
- The Allergy and Clinical Immunology Unit; Meir Hospital; Kfar-Saba affiliated with The Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - L. Eshayek
- The Allergy and Clinical Immunology Unit; Meir Hospital; Kfar-Saba affiliated with The Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - R. Confino-Cohen
- The Allergy and Clinical Immunology Unit; Meir Hospital; Kfar-Saba affiliated with The Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
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Wax D, Slater B, Goldberg A. Endotracheal tube exchange using a fibreoptic bronchoscope and a tube splitter. Anaesth Intensive Care 2014; 42:670-671. [PMID: 25233185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Goldberg A, Fitzmaurice G, Fortin J, McKetta S, Dean G, Drey E, Lichtenberg E, Bednarek P, Chen B, Dutton C, Maurer R, Winikoff B. Cervical preparation before second-trimester dilation and evacuation: a multicenter randomized trial comparing osmotic dilators alone to dilators plus adjunctive misoprostol or mifepristone. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.202] [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: 11/28/2022]
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Goldberg A, Storsley L. Teen donors, adult problems? Evaluating the long-term risks of living kidney donation from adolescents. Pediatr Transplant 2014; 18:319-20. [PMID: 24802337 DOI: 10.1111/petr.12251] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Goldberg
- Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
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Shah A, Schiopu E, Chatterjee S, Csuka M, Frech T, Goldberg A, Spiera R, Peng S, Steen V. OP0091 A Retrospective Look at the Recurrence of Digital Ulcers in Patients with Scleroderma after Discontinuation of Oral Treprostinil. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2257] [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: 11/04/2022]
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Goldberg A, Geppert T, Schiopu E, Frech T, Hsu V, Simms RW, Peng SL, Yao Y, Elgeioushi N, Chang L, Wang B, Yoo S. Dose-escalation of human anti-interferon-α receptor monoclonal antibody MEDI-546 in subjects with systemic sclerosis: a phase 1, multicenter, open label study. Arthritis Res Ther 2014; 16:R57. [PMID: 24559157 PMCID: PMC3978926 DOI: 10.1186/ar4492] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 01/29/2014] [Indexed: 01/30/2023] Open
Abstract
Introduction Type I interferons (IFNs) are implicated in the pathogenesis of systemic sclerosis (SSc). MEDI-546 is an investigational human monoclonal antibody directed against the type I IFN receptor. This Phase 1 study evaluated the safety/tolerability, pharmacokinetics (PK), immunogenicity, and pharmacodynamics (PD) of single and multiple intravenous doses of MEDI-546 in adults with SSc. Methods Subjects (≥18 years) with SSc were enrolled in an open-label, dose-escalation study to receive single (0.1, 0.3, 1.0, 3.0, 10.0, or 20.0 mg/kg), or 4 weekly intravenous doses (0.3, 1.0, or 5.0 mg/kg/week) of MEDI-546. Subjects were followed for 12 weeks. Safety assessments included adverse events (AEs), laboratory results, and viral monitoring. Blood samples were collected from all subjects for determination of PK, presence of anti-drug antibodies (ADAs), and expression of type I IFN-inducible genes. Results Of 34 subjects (mean age 47.4 years), 32 completed treatment and 33 completed the study. Overall, 148 treatment-emergent AEs (TEAEs) were reported (68.9% mild, 27.7% moderate). TEAEs included one grade 1 infusion reaction (5.0 mg/kg/week multiple dose). Of 4 treatment-emergent serious AEs (skin ulcer, osteomyelitis, vertigo, and chronic myelogenous leukemia (CML)), only CML (1.0 mg/kg/week multiple dose) was considered possibly treatment-related. MEDI-546 exhibited non-linear PK at lower doses. ADAs were detected in 5 subjects; no apparent impact on PK was observed. Peak inhibition of the type I IFN signature in whole blood was achieved within 1 day and in skin after 7 days. Conclusion The safety/tolerability, PK, and PD profiles observed in this study support further clinical development of MEDI-546. Trial Registration ClinicalTrials.gov NCT00930683
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Taghavi S, Beyer C, Vora H, Jayarajan S, Toyoda Y, Dujon J, Sjoholm L, Pathak A, Santora T, Goldberg A, Rappold J. Noncardiac Surgical Procedures in Patients on Mechanical Circulatory Support. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.571] [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: 10/25/2022]
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Smith R, McIlwraith W, Schweitzer R, Kadler K, Cook J, Caterson B, Dakin S, Heinegård D, Screen H, Stover S, Crevier-Denoix N, Clegg P, Collins M, Little C, Frisbie D, Kjaer M, van Weeren R, Werpy N, Denoix JM, Carr A, Goldberg A, Bramlage L, Smith M, Nixon A. Advances in the understanding of tendinopathies: A report on the Second Havemeyer Workshop on equine tendon disease. Equine Vet J 2013; 46:4-9. [DOI: 10.1111/evj.12128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- R. Smith
- Department of Veterinary Clinical Sciences and Services; The Royal Veterinary College; UK
| | - W. McIlwraith
- Clinical Sciences; Orthopaedic Research Center; Colorado State University; USA
| | - R. Schweitzer
- SOM-Cell and Developmental Biology Department; Oregon Health and Science University; USA
| | - K. Kadler
- Faculty of Life Sciences; University of Manchester; UK
| | - J. Cook
- Department of Physiotherapy; School of Primary Health Care; Monash University; Victoria Australia
| | | | - S. Dakin
- Department of Veterinary Clinical Sciences and Services; The Royal Veterinary College; UK
| | | | - H. Screen
- The School of Engineering and Materials Science; Queen Mary, University of London; UK
| | | | - N. Crevier-Denoix
- Ecole Vétérinaire d'Alfort; UMR INRA-ENVA BPLC (Biomécanique du Cheval); France
| | | | - M. Collins
- Department of Human Biology; UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM); South Africa
| | - C. Little
- Raymond Purves Bone and Joint Research Laboratories; Kolling Institute of Medical Research; E25 - Royal North Shore Hospital; University of Sydney; New South Wales Australia
| | - D. Frisbie
- Clinical Sciences; Colorado State University; USA
| | - M. Kjaer
- Department of Clinical Medicine; Section of Orthopaedics and Internal Medicine; Bispejerg Hospital; Denmark
| | - R. van Weeren
- Equine Sciences; Utrecht University; the Netherlands
| | - N. Werpy
- Veterinary Medicine and Surgery; University of Florida; USA
| | | | - A. Carr
- Nuffield Department of Orthopaedics; Rheumatology and Musculoskeletal Sciences; Nuffield Orthopaedic Centre; University of Oxford; UK
| | | | - L. Bramlage
- Rood and Riddle Equine Hospital; Kentucky USA
| | | | - A. Nixon
- Clinical Sciences; Cornell University; New York USA
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Wiebe C, Pochinco D, Blydt-Hansen TD, Ho J, Birk PE, Karpinski M, Goldberg A, Storsley LJ, Gibson IW, Rush DN, Nickerson PW. Class II HLA epitope matching-A strategy to minimize de novo donor-specific antibody development and improve outcomes. Am J Transplant 2013; 13:3114-22. [PMID: 24164958 DOI: 10.1111/ajt.12478] [Citation(s) in RCA: 265] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 01/25/2023]
Abstract
De novo donor-specific antibody (dnDSA) develops in 15-25% of renal transplant recipients within 5 years of transplantation and is associated with 40% lower graft survival at 10 years. HLA epitope matching is a novel strategy that may minimize dnDSA development. HLAMatchmaker software was used to characterize epitope mismatches at 395 potential HLA-DR/DQ/DP conformational epitopes for 286 donor-recipient pairs. Epitope specificities were assigned using single antigen HLA bead analysis and correlated with known monoclonal alloantibody epitope targets. Locus-specific epitope mismatches were more numerous in patients who developed HLA-DR dnDSA alone (21.4 vs. 13.2, p < 0.02) or HLA-DQ dnDSA alone (27.5 vs. 17.3, p < 0.001). An optimal threshold for epitope mismatches (10 for HLA-DR, 17 for HLA-DQ) was defined that was associated with minimal development of Class II dnDSA. Applying these thresholds, zero and 2.7% of patients developed dnDSA against HLA-DR and HLA-DQ, respectively, after a median of 6.9 years. Epitope specificity analysis revealed that 3 HLA-DR and 3 HLA-DQ epitopes were independent multivariate predictors of Class II dnDSA. HLA-DR and DQ epitope matching outperforms traditional low-resolution antigen-based matching and has the potential to minimize the risk of de novo Class II DSA development, thereby improving long-term graft outcome.
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Affiliation(s)
- C Wiebe
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
We performed a systematic review and meta-analysis of modern total ankle replacements (TARs) to determine the survivorship, outcome, complications, radiological findings and range of movement, in patients with end-stage osteoarthritis (OA) of the ankle who undergo this procedure. We used the methodology of the Cochrane Collaboration, which uses risk of bias profiling to assess the quality of papers in favour of a domain-based approach. Continuous outcome scores were pooled across studies using the generic inverse variance method and the random-effects model was used to incorporate clinical and methodological heterogeneity. We included 58 papers (7942 TARs) with an interobserver reliability (Kappa) for selection, performance, attrition, detection and reporting bias of between 0.83 and 0.98. The overall survivorship was 89% at ten years with an annual failure rate of 1.2% (95% confidence interval (CI) 0.7 to 1.6). The mean American Orthopaedic Foot and Ankle Society score changed from 40 (95% CI 36 to 43) pre-operatively to 80 (95% CI 76 to 84) at a mean follow-up of 8.2 years (7 to 10) (p < 0.01). Radiolucencies were identified in up to 23% of TARs after a mean of 4.4 years (2.3 to 9.6). The mean total range of movement improved from 23° (95% CI 19 to 26) to 34° (95% CI 26 to 41) (p = 0.01). Our study demonstrates that TAR has a positive impact on patients’ lives, with benefits lasting ten years, as judged by improvement in pain and function, as well as improved gait and increased range of movement. However, the quality of evidence is weak and fraught with biases and high quality randomised controlled trials are required to compare TAR with other forms of treatment such as fusion. Cite this article: Bone Joint J 2013;95-B:1500–7.
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Affiliation(s)
- R. Zaidi
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - S. Cro
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - K. Gurusamy
- University College London, Department
of Surgery, Royal Free Campus, Pond
Street, London NW3 2QG, UK
| | - N. Sivanadarajah
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - A. Macgregor
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - A. Henricson
- Falu Central Hospital, Department
of Orthopaedic Surgery, Falun, Sweden
| | - A. Goldberg
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
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Kane B, Nguyen M, Barracco R, Stello B, Goldberg A, Lenhart C, Porter B, Kurt A, Greenberg M. Sex Differences in Emergency Department Patient Mechanical Fall Risk and Openness to Communication with Providers. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.121] [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: 10/26/2022]
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Greenberg M, Nguyen M, Porter B, Barracco R, Stello B, Goldberg A, Lenhart C, Kurt A, Kane B. Modified CAGE as a Screening Tool for Mechanical Fall Risk Assessment: A Pilot Survey. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.122] [Citation(s) in RCA: 2] [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: 11/29/2022]
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