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Purswani J, Goldberg E, Cahlon O, Schnabel F, Axelrod D, Guth A, Perez CA, Shaikh F, Tam M, Formenti SC, Reig B, Gerber NK. A Radiation Therapy Contouring Atlas for Delineation of the Level I-II Axilla in the Prone Position. Int J Radiat Oncol Biol Phys 2023; 117:e200. [PMID: 37784852 DOI: 10.1016/j.ijrobp.2023.06.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) When patients are treated prone for whole breast irradiation (WBI), the axilla typically receives less dose than when patients are treated with WBI in the supine position. There are situations, however, where the axilla is a target as in a situation where the physician intends to treat with "high tangents" to provide good coverage of both the breast and level I-II axilla. In these scenarios, ideal target delineation when the patient is in the prone position is not well-defined. While different consensus guidelines exist for delineation of the nodal areas in the supine position, to our knowledge there are no contouring guidelines for the regional nodes in the prone position based on bone, skin, vascular and muscle landmarks. MATERIALS/METHODS Forty-three patients treated with high tangents in the prone position from 2012-2018 were identified as representative cases. The level I and II regional nodal contours from the Radiation Therapy Oncology Group (RTOG) breast cancer atlas were adapted for prone position by a radiation oncologist and a breast radiologist based on anatomic considerations and changes observed from supine to prone positioning on diagnostic imaging. The revised nodal contours were reviewed by an expanded expert multidisciplinary panel including additional breast radiation oncologists and surgical oncologists to delineate the level I and II axilla on noncontrast computed tomography (CT) scans. RESULTS We adapted the RTOG breast cancer atlas, supported by detailed figures, in order to create a CT based atlas of the level I and II axillary lymph node stations in the prone position. For the level I axilla, the cranial and caudal anatomic boundaries remain unchanged. With transition to the prone position from supine, tenting of the pectoralis major occurs displacing the muscle from the chest wall and shifting the axillary space anteromedial to the lateral border of the pectoralis major. Therefore, the anterior boundary is now defined by the plane of the anterior extent of the pectoralis major to skin. The medial boundary is defined by the plane of the lateral border of the pectoralis major and pectoralis minor including to ribs and intercostal muscles. The lateral boundary is defined by the skin, cropped by 5mm. The posterior boundary is defined by the plane of the anterior surface of the latissimus dorsi and subscapularis muscle to skin. For the level II axilla, the cranial, posterior, medial and lateral boundaries remain unchanged. With transition from supine to prone, the axilla exhibits an anterolateral shift, now laterally abutting the lateral border of the pectoralis minor. The anterior boundary is now defined as the posterior aspect of the pectoralis major muscle. The caudal boundary is where the pectoralis minor inserts into ribs. CONCLUSION The adaptations to the RTOG breast cancer atlas for prone positioning will enable radiation oncologists to more accurately target the level I and II axilla when treating patients prone in whom the axilla is a target in addition to the breast.
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Affiliation(s)
- J Purswani
- Department of Surgery, NYU Langone Health and Perlmutter Cancer Center, New York, NY
| | - E Goldberg
- New York University Grossman School of Medicine, New York, NY
| | - O Cahlon
- New York University Langone Health, New York, NY
| | - F Schnabel
- NYU Grossman School of Medicine, New York, NY
| | - D Axelrod
- Department of Surgery, NYU Langone Health and Perlmutter Cancer Center, New York, NY
| | - A Guth
- NYU Grossman School of Medicine, New York, NY
| | - C A Perez
- Department of Radiation Oncology, NYU Langone Health and Perlmutter Cancer Center, New York, NY
| | - F Shaikh
- NYU School of Medicine, New York, NY
| | - M Tam
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | | | - B Reig
- New York University Grossman School of Medicine, New York, NY
| | - N K Gerber
- Department of Radiation Oncology, NYU Langone Health, New York, NY
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Nishikawa M, Carey M, Ladanyi A, Mondellini G, Pinsino A, Antler K, Goldberg E, Hastie J, Clerkin K, Sayer G, Uriel N, Takeda K, Colombo P, Yuzefpolskaya M. Impact of Perioperative Sarcopenia and Dysphagia on LVAD Related Complications. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.779] [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: 04/05/2023] Open
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Carey M, Ladanyi A, Bohn B, Nishikawa M, Mondellini G, Pinsino A, Goldberg E, Kleet A, Sayer G, Uriel N, Aaron J, Uhlemann A, Takeda K, Demmer R, Colombo P, Yuzefpolskaya M. Impact of Perioperative Dysphagia and Oral Microbiome on Postoperative Pneumonia after LVAD. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1568] [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: 04/05/2023] Open
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Lin M, Burke R, Goldberg E, Hwang U, Burke L. 136 Ambulatory Follow-up After Emergency Department Discharge and Association With Outcomes Among Older Adults With Alzheimer’s Disease and Related Dementia. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.160] [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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LaRoche KJ, Martzke A, Doctoroff J, Goldberg E, Foster AM. Incidents of violence and disruption reported by the National Abortion Federation's Canadian members in 2017. Contraception 2021; 106:75-77. [PMID: 34587502 DOI: 10.1016/j.contraception.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore violence and disruption events reported by Canadian facilities providing abortion care in 2017, when only 3 provinces had passed safe access zone legislation. METHODS We reviewed self-reported data from 16 of 38 Canadian members of the National Abortion Federation. RESULTS Twelve facilities in 7 provinces reported 571 instances of picketing (97%), trespassing (>1%), threats of harm (>2%), and harassing calls/mail/emails (2%); 4 facilities reported no incidents. Freestanding clinics reported more picketing than hospital-based facilities. DISCUSSION Abortion providing facilities in Canada experienced picketing and other kinds of violence and disruption in 2017. These data serve as a baseline for future studies.
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Affiliation(s)
- Kathryn J LaRoche
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Amelia Martzke
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jill Doctoroff
- National Abortion Federation Canada, Vancouver, BC, Canada
| | - E Goldberg
- National Abortion Federation, Washington, DC, United States
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institute of Population Health, University of Ottawa, Ottawa, ON, Canada.
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Bingaman C, Wang R, Haut A, Hester J, Perera S, Goldberg E, Ranney M. 3 MyCOVIDrisk: User Experience Study Of COVID-19 Risk Assessment and Mitigation Application. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.07.004] [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: 11/29/2022]
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7
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Siegert S, Yonan C, Longo N, Cratty H, Nicosia M, Sampalis J, Carmack T, Dhanda R, Farahmand K, Lundt L, Angelov A, Goldberg E. Real-world evaluation of patient characteristics and disease management in long-term valbenazine treatment in adults with Tardive dyskinesia. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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King JB, Jones KG, Goldberg E, Rollins M, MacNamee K, Moffit C, Naidu SR, Ferguson MA, Garcia-Leavitt E, Amaro J, Breitenbach KR, Watson JM, Gurgel RK, Anderson JS, Foster NL. Increased Functional Connectivity After Listening to Favored Music in Adults With Alzheimer Dementia. J Prev Alzheimers Dis 2020; 6:56-62. [PMID: 30569087 DOI: 10.14283/jpad.2018.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Personalized music programs have been proposed as an adjunct therapy for patients with Alzheimer disease related dementia, and multicenter trials have now demonstrated improvements in agitation, anxiety, and behavioral symptoms. Underlying neurophysiological mechanisms for these effects remain unclear. METHODS We examined 17 individuals with a clinical diagnosis of Alzheimer disease related dementia using functional MRI following a training period in a personalized music listening program. RESULTS We find that participants listening to preferred music show specific activation of the supplementary motor area, a region that has been associated with memory for familiar music that is typically spared in early Alzheimer disease. We also find widespread increases in functional connectivity in corticocortical and corticocerebellar networks following presentation of preferred musical stimuli, suggesting a transient effect on brain function. CONCLUSIONS Findings support a mechanism whereby attentional network activation in the brain's salience network may lead to improvements in brain network synchronization.
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Affiliation(s)
- J B King
- Jeffrey S. Anderson, 1A71 School of Medicine, 50 N Medical Drive, Salt Lake City, UT 84132,
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Bar S, Lecourtois A, Diouf M, Goldberg E, Bourbon C, Arnaud E, Domisse L, Dupont H, Gosset P. The association of lung ultrasound images with COVID-19 infection in an emergency room cohort. Anaesthesia 2020; 75:1620-1625. [PMID: 32520406 PMCID: PMC7300460 DOI: 10.1111/anae.15175] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
Lung ultrasound could facilitate the triage of patients with suspected COVID‐19 infection admitted to the emergency room. We developed a predictive model for COVID‐19 diagnosis based on lung ultrasound and clinical features. We used ultrasound to image the lung bilaterally at two anterior sites, one and two hands below each clavicle, and a posterolateral site that was the posterior transverse continuation from the lower anterior site. We studied 100 patients, 31 of whom had a COVID‐19 positive reverse transcriptase polymerase chain reaction. A positive test was independently associated with: quick sequential organ failure assessment score ≥1; ≥3 B‐lines at the upper site; consolidation and thickened pleura at the lower site; and thickened pleura line at the posterolateral site. The model discrimination was an area (95%CI) under the receiver operating characteristic curve of 0.82 (0.75–0.90). The characteristics (95%CI) of the model’s diagnostic threshold, applied to the population from which it was derived, were: sensitivity, 97% (83–100%); specificity, 62% (50–74%); positive predictive value, 54% (41–98%); and negative predictive value, 98% (88–99%). This model may facilitate triage of patients with suspected COVID‐19 infection admitted to the emergency room.
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Affiliation(s)
- S Bar
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Amiens, France
| | - A Lecourtois
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
| | - M Diouf
- Amiens University Hospital, Amiens, France
| | - E Goldberg
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Amiens, France
| | - C Bourbon
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
| | - E Arnaud
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
| | - L Domisse
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
| | - H Dupont
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Amiens, France
| | - P Gosset
- Emergency Medicine Department, Amiens University Hospital, Amiens, France
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Velichkovsky BM, Zabotkina VI, Nosovets ZA, Kotov AA, Zaidelman LY, Kartashov SI, Korosteleva AN, Malakhov DG, Orlov VA, Zinina AA, Goldberg E, Ushakov VL. Towards Semantic Brain Mapping Methodology Based on a Multidimensional Markup of Continuous Russian-Language Texts: an Attempt at Validation and Development. Sovrem Tekhnologii Med 2020; 12:14-25. [PMID: 34513049 PMCID: PMC8353677 DOI: 10.17691/stm2020.12.2.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Indexed: 11/14/2022] Open
Abstract
In the present study, we combine linguistic annotation of oral texts in Russian with the registration of BOLD signal in functional MRI experiments to determine how and where semantic categories are represented in the human brain. Using the same stimuli material, we also analyze the differences in cortical activation in three thematic domains: description of nature, description of working principles of technical devices and more self-referential texts, addressing the question of human identity in conflict situations. We discuss methodological problems within the two approaches (microanalysis and macroanalysis) to study brain activation in natural conditions, i.e. under a continuous speech flow. Within the thematic domain studies, only minimally significant differences in brain activation were registered during the listening to texts from the three thematic groups. This outcome leads to the conclusion that the approach of thematic group contrasts (cognitive subtraction methodology) is not sufficient to study the mechanisms of text comprehension, and should be replaced by the modeling of multidimensional representations of semantic categories in time. Within the semantic category approach, we describe the neurolinguistic process of text understanding as the activation of 15 clusters responsible for semantic categories (e.g. “Conflict”, “Mental”, “Social”). Our data demonstrate that the clusters are widely distributed across the human brain. In contrast to the previous studies, we suggest that deep subcortical structures are involved in the processing of certain categories as well. The observed lateralization of category processing underlines the involvement of the right hemisphere in the processing of meaning.
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Affiliation(s)
- B M Velichkovsky
- Professor, Corresponding Member of the Russian Academy of Sciences, Member of Academia Europaea (MAE), Chief Researcher, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia, , Russian State University for the Humanities, 6 Miusskaya Square, Moscow, 125993, Russia; Senior Professor, Technische Universität Dresden, Zellescher Weg 17, Room A221, Dresden, 01069, Germany
| | - V I Zabotkina
- Professor, Vice-rector, Russian State University for the Humanities, 6 Miusskaya Square, Moscow, 125993, Russia
| | - Z A Nosovets
- Student, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - A A Kotov
- Leading Researcher, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - L Ya Zaidelman
- Researcher, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - S I Kartashov
- Senior Engineer, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - A N Korosteleva
- Researcher, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - D G Malakhov
- Researcher, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - V A Orlov
- Researcher, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - A A Zinina
- Researcher, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - E Goldberg
- Professor, New York University School of Medicine, 550 1 Avenue, New York, NY 10016, USA
| | - V L Ushakov
- Leading Researcher, National Research Center "Kurchatov Institute", 1 Akademika Kurchatova Square, Moscow, 123182, Russia; Associate Professor, National Research Nuclear University MEPhI, 31 Kashirskoe Shosse, Moscow, 115409, Russia
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11
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Imber B, Chau K, Goldberg E, Joffe E, Yahalom J. GRADE 3A FOLLICULAR LYMPHOMA CAN BE EFFECTIVELY CONTROLLED WITH VERY LOW DOSE RADIATION THERAPY. Hematol Oncol 2019. [DOI: 10.1002/hon.60_2631] [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: 11/08/2022]
Affiliation(s)
- B.S. Imber
- Radiation Oncology; Memorial Sloan Kettering Cancer Center; New York United States
| | - K. Chau
- Radiation Oncology; Memorial Sloan Kettering Cancer Center; New York United States
| | - E. Goldberg
- School of Medicine; Mount Sinai; New York United States
| | - E. Joffe
- Lymphoma Service; Memorial Sloan Kettering Cancer Center; New York United States
| | - J. Yahalom
- Radiation Oncology; Memorial Sloan Kettering Cancer Center; New York United States
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Goldberg E, Imber B, Chau K, Joffe E, Yahalom J. Radiotherapy is an Effective Definitive Treatment for Limited Stage Grade 3A Follicular Lymphoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2018.11.057] [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: 10/27/2022]
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Cohen E, Margalit I, Shochat T, Goldberg E, Krause I. Gender differences in homocysteine concentrations, a population-based cross-sectional study. Nutr Metab Cardiovasc Dis 2019; 29:9-14. [PMID: 30459075 DOI: 10.1016/j.numecd.2018.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS High concentrations of homocysteine are considered a risk factor for atherosclerosis and coronary artery disease. The aim of this study was to assess whether or not there are gender differences in the plasma concentrations of homocysteine. METHODS AND RESULTS Data were collected from medical records of individuals examined at a screening center in Israel between the years 2000-2014. Cross sectional analysis was carried out on 9237 men and 4353 women. Mean (SD) age of the study sample was 48.4 (9.7) and 47.7 (9.7) years for men and women respectively. Average homocysteine concentrations were 12.6 (5.9) and 9.6 (3.2) μmol/L in men and women respectively (p < 0.001). Prevalence of homocysteine concentrations above 15 μmol/L was found to be significantly higher in men than in women; 15.5% vs 3.9% respectively (p < 0.001). Low concentrations of vitamin (B12 < 200 pmol/L) and low concentrations of folate (<12 nmol/L) were found to be significantly higher in men than in women 20.4% vs. 16.0% and 18.5% vs. 10.8% respectively. Compared to women, men had a significantly higher odds ratio (95% CI) of having homocysteine concentrations above 15 μmol/L: non adjusted model, 4.47 (3.80-5.26); adjusted model for age, smoking status, body mass index, diabetes mellitus, kidney function and low serum concentrations of vitamin B12 and folate, 3.44 (2.89-4.09). CONCLUSION Plasma homocysteine concentrations are higher in men than in women. This may be a contributing factor to gender differences for developing atherosclerosis and coronary artery disease.
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Affiliation(s)
- E Cohen
- Department of Medicine F - Recanati, Rabin Medical Center -Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - I Margalit
- Department of Medicine F - Recanati, Rabin Medical Center -Beilinson Hospital, Petach Tikva, Israel
| | - T Shochat
- Statistical Counselling Unit, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - E Goldberg
- Department of Medicine F - Recanati, Rabin Medical Center -Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - I Krause
- Department of Medicine F - Recanati, Rabin Medical Center -Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Cromwell EA, Roy S, Sankara DP, Weiss A, Stanaway J, Goldberg E, Pigott DM, Larson H, Vollset SE, Krohn K, Foreman K, Hotez P, Bhutta Z, Bekele BB, Edessa D, Kassembaum N, Mokdad A, Murray CJL, Hay SI. Slaying little dragons: the impact of the Guinea Worm Eradication Program on dracunculiasis disability averted from 1990 to 2016. Gates Open Res 2018; 2:30. [PMID: 30234196 PMCID: PMC6139381 DOI: 10.12688/gatesopenres.12827.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background: The objective of this study was to document the worldwide decline of dracunculiasis (Guinea worm disease, GWD) burden, expressed as disability-adjusted life years (DALYs), from 1990 to 2016, as estimated in the Global Burden of Disease study 2016 (GBD 2016). While the annual number of cases of GWD have been consistently reported by WHO since the 1990s, the burden of disability due to GWD has not previously been quantified in GBD. Methods: The incidence of GWD was modeled for each endemic country using annual national case reports. A literature search was conducted to characterize the presentation of GWD, translate the clinical symptoms into health sequelae, and then assign an average duration to the infection. Prevalence measures by sequelae were multiplied by disability weights to estimate DALYs. Results: The total DALYs attributed to GWD across all endemic countries (n=21) in 1990 was 50,725 (95% UI: 35,265-69,197) and decreased to 0.9 (95% UI: 0.5-1.4) in 2016. A cumulative total of 12,900 DALYs were attributable to GWD from 1990 to 2016. Conclusions: Using 1990 estimates of burden propagated forward, this analysis suggests that between 990,000 to 1.9 million DALYs have been averted as a result of the eradication program over the past 27 years.
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Affiliation(s)
- Elizabeth A Cromwell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Sharon Roy
- Centers for Disease Controls and Prevention, Atlanta, GA, USA
| | | | | | - Jeffrey Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Ellen Goldberg
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Heidi Larson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Stein Emil Vollset
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Kristopher Krohn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Kyle Foreman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Peter Hotez
- College of Medicine, Baylor University, Houston, TX, USA
| | | | | | | | - Nicholas Kassembaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Ali Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
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Cummings MJ, Goldberg E, Mwaka S, Kabajaasi O, Vittinghoff E, Katamba A, Cattamanchi A, Kenya-Mugisha N, Davis JL, Jacob ST. The sixth vital sign: HIV status assessment and severe illness triage in Uganda. Public Health Action 2017; 7:245-250. [PMID: 29584800 DOI: 10.5588/pha.17.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/27/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Four in-patient health facilities in western Uganda. Objective: To determine the impact of an innovative multi-modal quality improvement program on human immunodeficiency virus (HIV) status assessment and the impact of HIV status on severe illness conditions and mortality. Design: This was a staggered, pre-post quasi-experimental study designed to assess a multi-modal intervention (collaborative improvement meetings, audit and feedback, clinical mentoring) for improving quality of care following formal training in the management of severe illness in low-income settings. Results: From August 2014 to May 2015, 5759 patients were hospitalized, of whom 2451 (42.6%) had their HIV status assessed; 395 (16.1%) were HIV-infected. HIV-infected patients were significantly more likely to meet criteria for shock (27.5% vs. 15.1%, risk ratio [RR] 1.8, 95% confidence interval [CI] 1.7-1.9, P < 0.001) and severe respiratory distress (6.7% vs. 4.3%, RR 1.5, 95%CI 1.2-2.0, P < 0.001), and were significantly more likely to die in hospital (12.0% vs. 2.9%, RR 4.1, 95%CI 3.2-5.4, P < 0.001). There was no evidence of improved HIV status assessment during the intervention period (36.5% vs. 44.8%, +8.3%, 95%CI -8.3 to 24.8, P = 0.33). Conclusions: Hospitalized HIV-infected patients in western Uganda are at high risk for severe illness and death. Novel quality improvement strategies are needed to enhance hospital-based HIV testing in high-burden settings.
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Affiliation(s)
- M J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - E Goldberg
- ImpactMatters, New York, New York, USA.,Walimu, Kampala, Uganda
| | | | | | - E Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - A Katamba
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - J L Davis
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA.,Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - S T Jacob
- Walimu, Kampala, Uganda.,Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
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Kassebaum N, Kyu HH, Zoeckler L, Olsen HE, Thomas K, Pinho C, Bhutta ZA, Dandona L, Ferrari A, Ghiwot TT, Hay SI, Kinfu Y, Liang X, Lopez A, Malta DC, Mokdad AH, Naghavi M, Patton GC, Salomon J, Sartorius B, Topor-Madry R, Vollset SE, Werdecker A, Whiteford HA, Abate KH, Abbas K, Damtew SA, Ahmed MB, Akseer N, Al-Raddadi R, Alemayohu MA, Altirkawi K, Abajobir AA, Amare AT, Antonio CAT, Arnlov J, Artaman A, Asayesh H, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Bacha U, Betsu BD, Barac A, Bärnighausen TW, Baye E, Bedi N, Bensenor IM, Berhane A, Bernabe E, Bernal OA, Beyene AS, Biadgilign S, Bikbov B, Boyce CA, Brazinova A, Hailu GB, Carter A, Castañeda-Orjuela CA, Catalá-López F, Charlson FJ, Chitheer AA, Choi JYJ, Ciobanu LG, Crump J, Dandona R, Dellavalle RP, Deribew A, deVeber G, Dicker D, Ding EL, Dubey M, Endries AY, Erskine HE, Faraon EJA, Faro A, Farzadfar F, Fernandes JC, Fijabi DO, Fitzmaurice C, Fleming TD, Flor LS, Foreman KJ, Franklin RC, Fraser MS, Frostad JJ, Fullman N, Gebregergs GB, Gebru AA, Geleijnse JM, Gibney KB, Gidey Yihdego M, Ginawi IAM, Gishu MD, Gizachew TA, Glaser E, Gold AL, Goldberg E, Gona P, Goto A, Gugnani HC, Jiang G, Gupta R, Tesfay FH, Hankey GJ, Havmoeller R, Hijar M, Horino M, Hosgood HD, Hu G, Jacobsen KH, Jakovljevic MB, Jayaraman SP, Jha V, Jibat T, Johnson CO, Jonas J, Kasaeian A, Kawakami N, Keiyoro PN, Khalil I, Khang YH, Khubchandani J, Ahmad Kiadaliri AA, Kieling C, Kim D, Kissoon N, Knibbs LD, Koyanagi A, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kulikoff R, Kumar GA, Lal DK, Lam HY, Larson HJ, Larsson A, Laryea DO, Leung J, Lim SS, Lo LT, Lo WD, Looker KJ, Lotufo PA, Magdy Abd El Razek H, Malekzadeh R, Markos Shifti D, Mazidi M, Meaney PA, Meles KG, Memiah P, Mendoza W, Abera Mengistie M, Mengistu GW, Mensah GA, Miller TR, Mock C, Mohammadi A, Mohammed S, Monasta L, Mueller U, Nagata C, Naheed A, Nguyen G, Nguyen QL, Nsoesie E, Oh IH, Okoro A, Olusanya JO, Olusanya BO, Ortiz A, Paudel D, Pereira DM, Perico N, Petzold M, Phillips MR, Polanczyk GV, Pourmalek F, Qorbani M, Rafay A, Rahimi-Movaghar V, Rahman M, Rai RK, Ram U, Rankin Z, Remuzzi G, Renzaho AMN, Roba HS, Rojas-Rueda D, Ronfani L, Sagar R, Sanabria JR, Kedir Mohammed MS, Santos IS, Satpathy M, Sawhney M, Schöttker B, Schwebel DC, Scott JG, Sepanlou SG, Shaheen A, Shaikh MA, She J, Shiri R, Shiue I, Sigfusdottir ID, Singh J, Silpakit N, Smith A, Sreeramareddy C, Stanaway JD, Stein DJ, Steiner C, Sufiyan MB, Swaminathan S, Tabarés-Seisdedos R, Tabb KM, Tadese F, Tavakkoli M, Taye B, Teeple S, Tegegne TK, Temam Shifa G, Terkawi AS, Thomas B, Thomson AJ, Tobe-Gai R, Tonelli M, Tran BX, Troeger C, Ukwaja KN, Uthman O, Vasankari T, Venketasubramanian N, Vlassov VV, Weiderpass E, Weintraub R, Gebrehiwot SW, Westerman R, Williams HC, Wolfe CDA, Woodbrook R, Yano Y, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaki MES, Zegeye EA, Zuhlke LJ, Murray CJL, Vos T. Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study. JAMA Pediatr 2017; 171:573-592. [PMID: 28384795 PMCID: PMC5540012 DOI: 10.1001/jamapediatrics.2017.0250] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/16/2017] [Indexed: 01/06/2023]
Abstract
Importance Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. Objective To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion. Evidence Review Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss. Findings Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries. Conclusions and Relevance Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.
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Affiliation(s)
- Nicholas Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Hmwe Hmwe Kyu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Leo Zoeckler
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Katie Thomas
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Christine Pinho
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Zulfiqar A Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Public Health Foundation of India, Gurgaon-122002, National Capital Region, India
| | - Alize Ferrari
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Yohannes Kinfu
- Centre for Research & Action in Public Health, University of Canberra, Canberra, Australia
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Alan Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - George C Patton
- Murdoch Childrens Research Institute, University of Melbourne, Victoria, Australia
| | - Joshua Salomon
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Benn Sartorius
- School of Nursing and Public Health, University of KwaZulu-Natal, South African Medical Research Council/University of KwaZulu-Natal Gastrointestinal Cancer Research Center, Durban, South Africa
| | - Roman Topor-Madry
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Stein Emil Vollset
- Center for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Harvey A Whiteford
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | | | - Kaja Abbas
- Department of Population Health, Virginia Tech, Blacksburg
| | | | | | - Nadia Akseer
- The Hospital for Sick Children, Centre for Child Health, Toronto, Ontario, Canada
| | | | | | | | | | | | - Carl A T Antonio
- Department of Health Policy and Administration, University of Philippines-Manila, Manila, Philippines
| | - Johan Arnlov
- Department of Medical Services, Uppsala University, Uppsala, Sweden
- Dalarna University, Uppsala, Sweden
| | - Al Artaman
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Ashish Awasthi
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Umar Bacha
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | | | | | | | | | - Neeraj Bedi
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
| | | | - Adugnaw Berhane
- College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | | | | | | | | | - Boris Bikbov
- Department of Nephrology Issues of Transplanted Kidney, V. I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia
| | - Cheryl Anne Boyce
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Alexandra Brazinova
- Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Trnava, Slovakia
| | | | - Austin Carter
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Ferrán Catalá-López
- University of Valencia, Valencia, Spain
- Health Research Institute and CIBERSAM, Valencia, Spain
| | - Fiona J Charlson
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | | | | | | | - John Crump
- Departmentà Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | - Amare Deribew
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gabrielle deVeber
- The Hospital for Sick Children, Centre for Child Health, Toronto, Ontario, Canada
| | - Daniel Dicker
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Eric L Ding
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Manisha Dubey
- International Institute for Population Sciences, Mumbai, India
| | | | - Holly E Erskine
- Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
| | | | - Andre Faro
- Federal University of Sergipe, Aracaju, Brazil
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Joao C Fernandes
- Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal
| | - Daniel Obadare Fijabi
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | | | - Thomas D Fleming
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Luisa Sorio Flor
- Escola Nacional de Saúde Pública Sergio Arouca/Fiocruz, Rio De Janeiro, Brazil
| | - Kyle J Foreman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Maya S Fraser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Joseph J Frostad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Katherine B Gibney
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Mahari Gidey Yihdego
- Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Mizan-Tepi University, Ethiopia
| | | | | | | | - Elizabeth Glaser
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Audra L Gold
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Ellen Goldberg
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | - Harish Chander Gugnani
- Department of Microbiology, Departments of Epidemiology and Biostatistics, St James School of Medicine, the Quarter, Anguilla
| | - Guohong Jiang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | | | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | | | | | - Masako Horino
- Nevada Division of Public and Behavioral Health, Carson City, Nevada
| | | | - Guoqing Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | | | | | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India
- University of Oxford, Oxford, United Kingdom
| | - Tariku Jibat
- Wageningen University, Wageningen, Netherlands
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Catherine O Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Jost Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karlas University, Heidelberg, Germany
| | - Amir Kasaeian
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ibrahim Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Christian Kieling
- Federal University of Rio Grande de Sul, Porto Alegre, Brazil
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Niranjan Kissoon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Luke D Knibbs
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Kristopher J Krohn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | - Rachel Kulikoff
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | | | - Hilton Y Lam
- Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines
| | - Heidi J Larson
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anders Larsson
- Department of Medical Services, Uppsala University, Uppsala, Sweden
| | | | - Janni Leung
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Loon-Tzian Lo
- UnionHealth Associates LLC, St Louis, Missouri
- Alton Mental Health Center, Alton, Illinois
| | - Warren D Lo
- Department of Pediatrics, Department of Neurology, The Ohio State University, Columbus
| | | | - Paulo A Lotufo
- College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Reza Malekzadeh
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Mazidi
- Institute of Genetics and Developmental Biology, Key State Laboratory of Molecular Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Peter A Meaney
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | | | | | | | - George A Mensah
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Charles Mock
- School of Medicine, School of Global Health, University of Washington, Seattle
| | | | | | - Lorenzo Monasta
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Ulrich Mueller
- Federal Institute for Population Research, Wiesbaden, Germany
| | - Chie Nagata
- National Center for Child Health and Development, Tokyo, Japan
| | - Aliya Naheed
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Grant Nguyen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Quyen Le Nguyen
- Institute for Global Health, Duy Tan University, Da Nang, Vietnam
| | - Elaine Nsoesie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - In-Hwan Oh
- Department of Preventive Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea
| | | | | | | | | | - Deepak Paudel
- UK Department for International Development, Lalitpur, Nepal
| | | | - Norberto Perico
- Istituto di Richerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Max Petzold
- Health Metrics Unit, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | - Mostafa Qorbani
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Anwar Rafay
- Contect International Health Consultants, Lahore, Punjab, Pakistan
| | - Vafa Rahimi-Movaghar
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahfuzar Rahman
- Research and Evaluation Division, Building Resources Access Communities, Dhaka, Bangladesh
| | | | - Usha Ram
- International Institute for Population Sciences, Mumbai, India
| | - Zane Rankin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | | | - Luca Ronfani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Rajesh Sagar
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Institute of Health Care and Social Sciences, FOM University, Essen, Germany
| | | | - James G Scott
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Sadaf G Sepanlou
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amira Shaheen
- Department of Public Health, An-Najah University, Nablus, Palestine
| | | | - June She
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Work Organizations, Disability Program, University of Helsinki, Helsinki, Finland
| | - Ivy Shiue
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | | | | | - Naris Silpakit
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Alison Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Jeffrey D Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Caitlyn Steiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Karen M Tabb
- University of Illinois at Urbana-Champaign, Champaign
| | | | | | - Bineyam Taye
- Department of Biology, Colgate University, Hamilton, New York
| | - Stephanie Teeple
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Bernadette Thomas
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Alan J Thomson
- Adaptive Knowledge Management, Victoria, British Columbia, Canada
| | - Ruoyan Tobe-Gai
- National Center for Child Health and Development, Tokyo, Japan
| | | | | | - Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | | | | | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden
- Institute of Population-based Cancer Research, Cancer Registry of Norway, Oslo, Norway
| | | | | | - Ronny Westerman
- Federal Institute for Population Research, Wiesbaden, Germany
| | | | | | - Rachel Woodbrook
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Yuichiro Yano
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | | | - Seok-Jun Yoon
- Department of Preventive Medicine, School of Medicine, Korea University, Seoul, South Korea
| | | | | | | | | | | | | | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
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Goldberg E, Hansen LF, Komoto TT, Pohl BA, Howerton RJ, Dye RE, Plechaty EF, Warren WE. Neutron and Gamma-Ray Spectra from a Variety of Materials Bombarded with 14-MeV Neutrons. NUCL SCI ENG 2017. [DOI: 10.13182/nse90-a21468] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- E. Goldberg
- Lawrence Livermore National Laboratory, P. O. Box 808, Livermore, California 94551
| | - L. F. Hansen
- Lawrence Livermore National Laboratory, P. O. Box 808, Livermore, California 94551
| | - T. T. Komoto
- Lawrence Livermore National Laboratory, P. O. Box 808, Livermore, California 94551
| | - B. A. Pohl
- Lawrence Livermore National Laboratory, P. O. Box 808, Livermore, California 94551
| | - R. J. Howerton
- Lawrence Livermore National Laboratory, P. O. Box 808, Livermore, California 94551
| | - R. E. Dye
- Lawrence Livermore National Laboratory, P. O. Box 808, Livermore, California 94551
| | - E. F. Plechaty
- Lawrence Livermore National Laboratory, P. O. Box 808, Livermore, California 94551
| | - W. E. Warren
- Lawrence Livermore National Laboratory, P. O. Box 808, Livermore, California 94551
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Affiliation(s)
- D. W. Kneff
- Rockwell International Corporation, Canoga Park, California 91303
| | - B. M. Oliver
- Rockwell International Corporation, Canoga Park, California 91303
| | - E. Goldberg
- Lawrence Livermore National Laboratory, University of California Livermore, California 94550
| | - R. C. Haight
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
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Yahav D, Yassin S, Shaked H, Goldberg E, Bishara J, Paul M, Leibovici L. Risk factors for long-term mortality of Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 2016; 35:785-90. [PMID: 26873381 DOI: 10.1007/s10096-016-2598-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/25/2016] [Indexed: 12/20/2022]
Abstract
Staphylococcus aureus bacteremia (SAB) is a fatal disease. We aimed to describe risk factors for long-term mortality with SAB. We analyzed data from a retrospectively collected database including 1,692 patients with SAB. We considered variables of infection and background conditions for the analysis of long-term survival. The Kaplan-Meier procedure was used for analysis of long-term survival. Variables significantly associated with mortality were analyzed using a Cox regression model. We included 1,692 patients in the analysis. Patients were followed for up to 22 years. Within one year, 62% of patients died and within 5 years 72% died. A total of 82% of patients aged 65 years and older died within 5 years. Independent predictors of long-term mortality were older age (Hazard ratio 1.029, 95% confidence interval 1.022-1.036), female gender (HR 1.302, 95% CI 1.118-1.517), pneumonia or primary/ unknown source of infection (HR 1.441, 95% CI 1.230-1.689), dementia (HR 1.234, 95% CI 1.004-1.516), higher Charlson score (HR 1.155, 95% CI 1.115-1.196), shock at onset (HR 1.776, 95% CI 1.430-2.207) and arrival to hospitalization from an institution (HR 1.319, 95% CI 1.095-1.563). Long-term survival of patients older than 65 years and of women with SAB is severely curtailed.
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Affiliation(s)
- D Yahav
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah-Tikva, 49100, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.
| | - S Yassin
- Department of Medicine D, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - H Shaked
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah-Tikva, 49100, Israel
| | - E Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
- Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - J Bishara
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - M Paul
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
- Unit of Infectious Diseases, Rambam Hospital, Haifa, Israel
| | - L Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Harding B, Vossough A, Goldberg E, Santi M. Pontine tegmental cap dysplasia: neuropathological confirmation of a rare clinical/radiological syndrome. Neuropathol Appl Neurobiol 2015; 42:301-6. [DOI: 10.1111/nan.12281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/27/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- B. Harding
- Department of Pathology and Lab Medicine (Neuropathology); Children's Hospital of Philadelphia and the Perelman School of Medicine University of Pennsylvania; Philadelphia PA USA
| | - A. Vossough
- Department of Radiology; Children's Hospital of Philadelphia and the Perelman School of Medicine University of Pennsylvania; Philadelphia PA USA
| | - E. Goldberg
- Department of Neurology; Children's Hospital of Philadelphia and the Perelman School of Medicine University of Pennsylvania; Philadelphia PA USA
| | - M. Santi
- Department of Pathology and Lab Medicine (Neuropathology); Children's Hospital of Philadelphia and the Perelman School of Medicine University of Pennsylvania; Philadelphia PA USA
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Biderman P, Bugaevsky Y, Ben-Zvi H, Bishara J, Goldberg E. Multidrug-resistant Acinetobacter baumannii infections in lung transplant patients in the cardiothoracic intensive care unit. Clin Transplant 2015; 29:756-62. [PMID: 26065630 DOI: 10.1111/ctr.12575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multidrug-resistant (MDR) gram-negative bacteria are a growing threat to solid organ transplantation (SOT) patients in the intensive care unit (ICU). We aimed to examine the mortality rates of gram-negative MDR bacterial infection in SOT patients compared with patient population undergoing other cardiothoracic surgeries and hospitalized under similar ICU conditions. METHODS A retrospective study from a single medical center, including patients with MDR Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae infection, hospitalized in the cardiothoracic ICU. Data were collected from computerized databases, and data were verified using the hospitalization files. Microbiological data were provided by the microbiology laboratory. RESULTS During the study period, 205 SOT patients and 5031 other patients were hospitalized in the cardiothoracic ICU. Active infection with gram-negative MDR bacteria was identified in 147 patients, of which 37 underwent SOT (18% of total transplant recipients) and 110 underwent another cardiothoracic surgery (2% of total patients who are not transplant recipients). Mortality rates were high among both groups of patients, with no significant difference between them. CONCLUSIONS Infection with resistant bacteria is more prevalent among patients following SOT compared with patients following other cardiothoracic surgeries. Mortality is high in all patients regardless of the immunocompromised condition.
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Affiliation(s)
- P Biderman
- Cardio-Thoracic Intensive Care Unit, Rabin Medical Center, Petach-Tikva, Israel
| | - Y Bugaevsky
- Internal Medicine B, Rabin Medical Center, Petach-Tikva, Israel
| | - H Ben-Zvi
- Microbiology Laboratory, Rabin Medical Center, Petach-Tikva, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Bishara
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Petach-Tikva, Israel
| | - E Goldberg
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Petach-Tikva, Israel
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Kenedi P, O'Reilly V, Goldberg E. Association between intraventricular conduction defects, coronary artery disease and left ventricular function. Adv Cardiol 2015; 16:504-6. [PMID: 1274764 DOI: 10.1159/000398450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Steinmetz T, Eliakim-Raz N, Goldberg E, Leibovici L, Yahav D. Association of vancomycin serum concentrations with efficacy in patients with MRSA infections: a systematic review and meta-analysis. Clin Microbiol Infect 2015; 21:665-73. [PMID: 25887712 DOI: 10.1016/j.cmi.2015.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/29/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
Recent Infectious Diseases Society of America guidelines for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections recommend maintaining vancomycin trough concentrations of 15-20 mg/L for serious infections. We conducted a systematic review and meta-analysis of all studies assessing the impact of low (<15 mg/L) vs. high (≥ 15 mg/L) vancomycin trough level on the efficacy of MRSA infections treatment. Four prospective and 12 retrospective studies were included (2003 participants). No significant difference was demonstrated between low and high vancomycin trough level for the outcome of all-cause mortality (odds ratio (OR) 1.07, 95% confidence interval (CI) 0.78-1.46, I(2) = 28%). In studies evaluating mainly MRSA pneumonia, there was significantly higher mortality with low vancomycin level (OR 1.78, 95% CI 1.11-2.84). No significant difference was demonstrated in treatment failure rates (OR 1.25, 95% CI 0.88-1.78, I(2) = 51%). However, excluding one outlier study from the analysis, treatment failure became significantly higher in patients with low vancomycin trough level (OR 1.46, 95% CI 1.12-1.91, I(2) = 16%). Microbiologic failure rates were significantly higher in patients with low vancomycin levels (OR 1.56, 95% CI 1.08-2.26, I(2) = 0%). Nephrotoxicity was significantly higher with vancomycin levels of ≥ 15 mg/L. However, no cases of irreversible renal damage were reported. Current data on the effectiveness of higher vancomycin trough levels in the treatment of MRSA infections are limited to few prospective and mainly retrospective studies. Our findings support the current recommendations for maintaining vancomycin trough levels of ≥ 15 mg/L in the treatment of severe MRSA infections, although no difference in all-cause mortality was observed.
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Affiliation(s)
| | - N Eliakim-Raz
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - E Goldberg
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - L Leibovici
- Department of Medicine E, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - D Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Eliakim-Raz N, Fishman G, Yahav D, Goldberg E, Stein GY, Zvi HB, Barsheshet A, Bishara J. Predicting Clostridium difficile infection in diabetic patients and the effect of metformin therapy: a retrospective, case-control study. Eur J Clin Microbiol Infect Dis 2015; 34:1201-5. [PMID: 25686730 DOI: 10.1007/s10096-015-2348-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/02/2015] [Indexed: 12/18/2022]
Abstract
Data on risk factors for Clostridium difficile infection (CDI) in diabetic patients are scarce. Recently, it has been shown that metformin increases the Bacteroidetes/Firmicutes ratio; therefore, it may yield a protective effect against CDI. We aimed to assess risk factors for CDI in diabetic patients beyond antibiotic treatment, and to determine the impact of metformin therapy on the development of CDI in these patients. In this retrospective, case-control study, all consecutive CDI diabetic patients, from January 2009 to December 2013, were included and compared to consecutive diabetic patients without CDI, hospitalized during the same period and in the same departments. Of 7,670 patients tested for C. difficile toxins, 486 were diabetics. Of them, 150 (30.8 %) were positive for C. difficile toxins and 336 (69.1 %) were negative. On multivariate analysis, metformin treatment was associated with a significant reduction in CDI [odds ratio (OR) = 0.58; 95 % confidence interval (CI), 0.37-0.93; p = 0.023], while heart failure was associated with significantly higher rates of CDI (OR = 1.654; 95 % CI, 1.007-2.716; p = 0.047), together with poor functional status, previous hospitalization, and abdominal surgery. Our findings suggest that, in diabetic patients, in addition to the well-recognized risk factors, heart failure is an additional risk factor for CDI, while metformin treatment seems to have a protective effect against the development of CDI. The exact mechanisms underlying this protective effect remain to be fully understood.
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Affiliation(s)
- N Eliakim-Raz
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel,
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Orvin K, Goldberg E, Bernstine H, Groshar D, Sagie A, Kornowski R, Bishara J. The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis. Clin Microbiol Infect 2014; 21:69-76. [PMID: 25636930 DOI: 10.1016/j.cmi.2014.08.012] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/17/2014] [Accepted: 08/05/2014] [Indexed: 01/27/2023]
Abstract
The exact incidence of extra-cardiac complications (ECC) in patients with infective endocarditis (IE) is unknown but presumed to be high. These patients, although mostly asymptomatic, may require a more aggressive therapeutic approach. (18)fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used for the diagnosis of infections, but its role in the early diagnosis of IE complications is still unclear. This study aimed to evaluate the role of FDG-PET/CT in the early diagnosis of ECC in IE and its implications for medical management. We prospectively studied 40 consecutive patients with a confirmed diagnosis of IE (according to the modified Duke criteria) who underwent a whole body FDG-PET/CT study within 14 days from diagnosis. The FDG-PET/CT demonstrated ECC in 17 (42.5%) patients, while 8 (38.1%) of them were asymptomatic. The most frequent embolic sites were musculoskeletal and splenic. Owing to the FDG-PET/CT findings, treatment planning was modified in 14 (35%) patients. This included antibiotic treatment prolongation (27.5%), referral to surgical procedures (15%) and, most substantially, prevention of unnecessary device extraction (17.7%). According to our experiences, FDG-PET/CT imaging was useful in the detection of embolic and metastatic infections in IE. This clinical information had a significant diagnostic and therapeutic impact in managing IE disease.
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Affiliation(s)
- K Orvin
- Cardiology Department, Rabin Medical Centre, Petach Tikva, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - E Goldberg
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Rabin Medical Centre, Petach Tikva, Israel
| | - H Bernstine
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Nuclear Medicine Department, Rabin Medical Centre, Petach Tikva, Israel
| | - D Groshar
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Nuclear Medicine Department, Rabin Medical Centre, Petach Tikva, Israel
| | - A Sagie
- Cardiology Department, Rabin Medical Centre, Petach Tikva, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Kornowski
- Cardiology Department, Rabin Medical Centre, Petach Tikva, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Bishara
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Rabin Medical Centre, Petach Tikva, Israel
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Yahav D, Duskin-Bitan H, Eliakim-Raz N, Ben-Zvi H, Shaked H, Goldberg E, Bishara J. Monomicrobial necrotizing fasciitis in a single center: the emergence of Gram-negative bacteria as a common pathogen. Int J Infect Dis 2014; 28:13-6. [PMID: 25220388 DOI: 10.1016/j.ijid.2014.05.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a life-threatening soft tissue infection. It is usually caused by Streptococcus pyogenes and other Gram-positive bacteria. Several reports, however, emphasize the importance of Gram-negative rods in this infection. METHODS We retrospectively studied all cases of monomicrobial necrotizing fasciitis hospitalized in our center during the years 2002-2012. We compared clinical characteristics and outcomes of patients with Gram-negative versus Gram-positive infection. RESULTS Forty-five cases were reviewed, 19 caused by Gram-negative organisms, 10 of them Escherichia coli, and 26 caused by Gram-positive organisms, 10 of them S. pyogenes. Compared to Gram-positive infections, patients with Gram-negative infections were more likely to have a baseline malignancy (9/19, 47.4%) or to have undergone recent surgery (4/19, 42.3%). The 30-day mortality was higher among Gram-negative infected patients (8/19, 42.1% vs. 8/26, 30.8%). Creatine phosphokinase (CPK) was elevated in a minority of patients with Gram-negative necrotizing fasciitis, and its absolute value was lower than in Gram-positive necrotizing fasciitis. CONCLUSIONS In our center, 42% of monomicrobial necrotizing fasciitis cases were found to be caused by Gram-negative organisms, mostly E. coli. These infections usually appeared in immunocompromised or postoperative patients, often presented with normal CPK levels, and were associated with high mortality rates.
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Affiliation(s)
- D Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - H Duskin-Bitan
- Department of Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - N Eliakim-Raz
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Ben-Zvi
- Department of Clinical Microbiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - H Shaked
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - E Goldberg
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Onuigbo M, Agbasi N, Wu MJ, Shu KH, Kugler E, Cohen E, Krause I, Goldberg E, Garty M, Krause I, Jansen J, De Napoli IE, Schophuizen CM, Wilmer MJ, Mutsaers HA, Heuvel LP, Grijpma DW, Stamatialis D, Hoenderop JG, Masereeuw R, Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, Vrints CJ, Hoymans VY, Couttenye MM, Erkmen Uyar M, Tutal E, Bal Z, Guliyev O, Sezer S, Liu L, Wang C, Tanaka K, Kushiyama A, Sakai K, Hara S, Ubara Y, Ohashi Y, Kunugi Y, Kawazu S, Untersteller K, Seiler S, Rogacev KS, Emrich IE, Lennartz CS, Fliser D, Heine GH, Hoshino T, Ookawara S, Miyazawa H, Ueda Y, Ito K, Kaku Y, Hirai K, Mori H, Yoshida I, Kakuta S, Hayama N, Amemiya M, Okamoto H, Inoue S, Tabei K, Campos P, Dias C, Baptista J, Papoila AL, Ortiz A, Inchaustegui L, Soto K, Moon KH, Yang S, Lee DY, Kim HW, Kim B, Isnard Bagnis C, Guerraoui A, Zenasni F, Idier L, Chauveau P, Cerqueira A, Quelhas-Santos J, Pestana M, Choi JY, Jin DC, Choi YJ, Kim WY, Nam SA, Cha JH, Cernaro V, Loddo S, Lacquaniti A, Romeo A, Costantino G, Montalto G, Santoro D, Trimboli D, Ricciardi CA, Lacava V, Buemi M, Emrich IE, Zawada AM, Rogacev KS, Seiler S, Obeid R, Geisel J, Fliser D, Heine GH, Meneses GC, Silva Junior G, Costa MFB, Goncalves HS, Daher EF, Liborio AB, Martins AMC, Ekart R, Hojs N, Bevc S, Hojs R, Lim CS, Hwang JH, Chin HJ, Kim S, Kim DK, Kim S, Park JH, Shin SJ, Lee SH, Choi BS, Lemoine S, Panaye M, Juillard L, Dubourg L, Hadj-Aissa A, Guebre-Egziabher F, Silva Junior G, Vieira APF, Couto Bem AX, Alves MP, Meneses GC, Martins AMC, Liborio AB, Daher EF, Ito K, Ookawara S, Miyazawa H, Ueda Y, Kaku Y, Hirai K, Hoshino T, Mori H, Yoshida I, Tabei K, Stefan G, Capusa C, Stancu S, Margarit D, Petrescu L, Nedelcu ED, Mircescu G, Szarejko-Paradowska A, Rysz J, Hung CC, Chen HC, Ristovska V, Grcevska L, Podesta MA, Reggiani F, Cucchiari D, Badalamenti S, Buemi M, Ponticelli C, Graziani G, Nouri-Majalan N, Moghadasimousavi S, Eshaghyeh Z, Greenwood S, Koufaki P, Maclaughlin H, Rush R, Hendry BM, Macdougall IC, Mercer T, Cairns H. CKD LAB METHODS, PROGRESSION & RISK FACTORS 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu165] [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: 01/30/2023] Open
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Davids MR, Marais N, Jacobs J, Cohen E, Krause I, Goldberg E, Garty M, Krause I, Dursun B, Sahan Y, Tanriverdi H, Rota S, Uslu S, Senol H, Minutolo R, Gabbai FB, Agarwal R, Chiodini P, Borrelli S, Stanzione G, Nappi F, Bellizzi V, Conte G, De Nicola L, Van De Walle J, Johnson S, Fremeaux-Bacchi V, Ardissino G, Ariceta G, Beauchamp J, Cohen D, Greenbaum LA, Ogawa M, Schaefer F, Licht C, Scalzotto E, Nalesso F, Zaglia T, Corradi V, Neri M, Martino F, Zanella M, Brendolan A, Mongillo M, Ronco C, Chinnappa S, Mooney A, El Nahas AM, Tu YK, Tan LB, Jung JY, Kim AJ, Ro H, Lee C, Chang JH, Lee HH, Chung W, Clarke AL, Young HM, Hull KL, Hudson N, Burton JO, Smith AC, Marx S, Petrilla A, Filipovic I, Lee WC, Meijers B, Poesen R, Storr M, Claes K, Kuypers D, Evenepoel P, Aukland M, Clarke AL, Hull KL, Burton JO, Smith AC, Betriu A, Martinez-Alonso M, Arcidiacono MV, Cannata-Andia J, Pascual J, Valdivielso JM, Fernandez-Giraldez E, Kingswood JC, Zonnenberg B, Sauter M, Zakar G, Biro B, Besenczi B, Varga A, Pekacs P, Pizzini P, Pisano A, Leonardis D, Panuccio V, Cutrupi S, Tripepi G, Mallamaci F, Zoccali C, Arnold J, Baharani J, Rayner H, So BH, Blackwell S, Jardine AG, Macgregor MS, Cunha C, Barreto P, Pereira S, Ventura A, Mota M, Seabra J, Sakaguchi T, Kobayashi S, Yano T, Yoshimoto W, Bancu I, Bonal Bastons J, Cleries Escayola M, Vela Vallespin E, Bustins Poblet M, Magem Luque D, Pastor Fabregas M, Chen JH, Chen SC, Chang JM, Hwang SJ, Chen HC, Ahbap E, Kara E, Basturk T, Sahutoglu T, Koc Y, Sakaci T, Sevinc M, Akgol C, Ozagari AA, Unsal A, Minami S, Hesaka A, Yamaguchi S, Iwahashi E, Sakai S, Fujimoto T, Sasaki K, Fujita Y, Yokoyama K, Marks A, Fluck N, Prescott G, Robertson L, Smith WC, Black C, Ohsawa M, Fujioka T, Omori S, Isurugi T, Tanno K, Onoda T, Omama S, Ishibashi Y, Makita S, Okayama A, Garland JS, Simpson CS, Metangi MF, Parfrey B, Johri AM, Sloan L, McAuley J, Cunningham R, Mullan R, Quinn M, Harron C, Chiu H, Murphy-Burke D, Werb R, Jung B, Chan-Yan C, Duncan J, Forzley B, Lowry R, Hargrove G, Carson R, Levin A, Karim M, Reznik EV, Storozhakov GIV, Rollino C, Troiano M, Bagatella M, Liuzzo C, Quarello F, Roccatello D, Blaslov K, Bulum T, Prka In I, Duvnjak L, Heleniak Z, Ciepli ska M, Szychli ski T, Pryczkowska M, Bartosi ska E, Wiatr H, Kot owska H, Tylicki L, Rutkowski B, Song YR, Kim SGK, Kim HJ, Noh JW, Tong A, Jesudason S, Craig JC, Winkelmayer WC, Hung PH, Huang YT, Hsiao CY, Sung PS, Guo HR, Tsai KJ, Wu CC, Su SL, Kao SY, Lu KC, Lin YF, Lin WH, Lee HM, Cheng MF, Wang WM, Yang LY, Wang MC, Vukovic Lela I, Sekoranja M, Poljicanin T, Karanovic S, Abramovic M, Matijevic V, Stipancic Z, Leko N, Cvitkovic A, Dika Z, Kos J, Laganovic M, Grollman AP, Jelakovic B, Dryl-Rydzynska T, Prystacki T, Malyszko J, Trifiro G, Sultana J, Giorgianni F, Ingrasciotta Y, Muscianisi M, Tari DU, Perrotta M, Buemi M, Canale V, Arcoraci V, Santoro D, Rizzo M, Iheanacho I, Van Nooten FE, Goldsmith D, Grandtnerova B, Berat ova Z, ErvenOva M, cErven J, Markech M, tefanikova A, Engelen W, Elseviers M, Gheuens E, Colson C, Muyshondt I, Daelemans R. CKD GENERAL AND CLINICAL EPIDEMIOLOGY 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu167] [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: 11/12/2022] Open
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Goldberg E, Amir I, Zafran M, Gophna U, Samra Z, Pitlik S, Bishara J. The correlation between Clostridium-difficile infection and human gut concentrations of Bacteroidetes phylum and clostridial species. Eur J Clin Microbiol Infect Dis 2013; 33:377-83. [DOI: 10.1007/s10096-013-1966-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
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Griswold MD, Eddy M, Goldberg E. In Memoriam: Norman B. Hecht, Ph.D. * 1940-2013. Biol Reprod 2013. [DOI: 10.1095/biolreprod.113.110601] [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: 11/01/2022] Open
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Gakhar N, Goldberg E, Jing M, Gibson R, House JD. Effect of feeding hemp seed and hemp seed oil on laying hen performance and egg yolk fatty acid content: evidence of their safety and efficacy for laying hen diets. Poult Sci 2012; 91:701-11. [PMID: 22334746 DOI: 10.3382/ps.2011-01825] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Forty-eight 19-wk-old Bovan White laying hens were fed 1 of 5 diets containing either hemp seed (HS) or hemp seed oil (HO). The level of HO was 4, 8, or 12%, whereas the level was 10 or 20% for the HS. A set of 8 birds fed wheat-, barley-, and corn oil-based diets served as the control. Performance was monitored over 12 wk. Average hen-day egg production was not affected upon feeding of either HS or HO diets. Egg weight was higher than that of the controls for hens consuming the 20% HS diet (P < 0.05). Feed intake was lower than that of the controls for birds consuming the 4% HO diet but similar across other treatments. Final BW were not affected by diet, with the exception of being lower than that of the controls (P < 0.05) in hens consuming the 12% HO diet. The total egg yolk n-3 fatty acid content increased linearly (P < 0.05) with increasing dietary α-linolenic acid provision with the HS- or HO-based diets. A quadratic response (P < 0.05) was observed for docosahexaenoic acid levels in egg yolk in response to increasing dietary α-linolenic acid supply. The expression of hepatic fatty acid desaturase 1 and 2, key genes for the desaturation of long-chain polyunsaturated fatty acids, was significantly decreased (50-60% of controls; P < 0.05) as a result of feeding HS or HO diets. Based on the results from the current study, the inclusion of the hemp products HS or HO in the diets of laying hens up to a maximum level of 20 and 12%, respectively, does not adversely effect the performance of laying hens and leads to the enrichment of the n-3 fatty acid content of eggs.
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Affiliation(s)
- N Gakhar
- Department of Animal Science, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
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Goldberg E, Bishara J, Lev S, Singer P, Cohen J. Organ transplantation from a donor colonized with a multidrug-resistant organism: a case report. Transpl Infect Dis 2011; 14:296-9. [PMID: 22176504 DOI: 10.1111/j.1399-3062.2011.00697.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 06/15/2011] [Accepted: 09/07/2011] [Indexed: 12/16/2022]
Abstract
The number of intensive care unit patients with infections caused by multidrug-resistant organisms is increasing in most developed countries. We report the case of a deceased multiorgan donor, who was an asymptomatic carrier of carbapenem-resistant Klebsiella pneumoniae (CR-KP) in the respiratory tract, a condition that was not diagnosed before organ harvesting and transplantation. The outcome of the 2 kidney recipients, the liver recipient, and 1 of the lung recipients was uneventful; in particular, no evidence of infection transmission or adverse graft outcomes was noted. The other lung recipient had a complicated postoperative course and, 4 weeks post transplantation, he developed a bacteremic pneumonia with CR-KP from which he subsequently died. These results suggest that, in well defined conditions, organs from donors who are CR-KP positive may be considered for transplantation.
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Affiliation(s)
- E Goldberg
- Unit of Infectious Diseases, Rabin Medical Center, Petah Tikva, Israel
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Goldberg E, Coyle K, Su Y, DeKoven M, Chapman R, Wagner S. 6617 POSTER Impact of Asian Ethnicity in Gastric Cancer Survival – a Literature Review. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71928-1] [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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Pavol M, Goldberg E, Mohr JP, Ruff I, Lazar R. Severe aphasia following infarction in the territory of the left anterior choroidal artery. Cerebrovasc Dis 2011; 32:197-8. [PMID: 21849781 DOI: 10.1159/000328242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Marykay Pavol
- Stroke Division, Department of Neurology, Columbia University Medical Center, 710 W. 168th Street, New York, NY 10032, USA.
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Goldberg E, Unglaub F, Kneser U, Horch RE. [Intraarticular fractures of the proximal interphalangeal joint: dynamic early functional therapy with an external fixation system]. Unfallchirurg 2009; 112:337-45. [PMID: 19224186 DOI: 10.1007/s00113-008-1553-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The results of treating fracture dislocations of the proximal interphalangeal joint are often unsatisfactory for the patient because conservative methods cannot prevent stiffness of the joint. Thus, early functional treatment with external fixation systems is increasingly favoured. This therapy combines the principles of ligamentotaxis and the possibility of early movement of the injured joint. The frequently modified pins and rubbers traction system is especially effective. It is cheap, easy to apply, and well accepted by patients due to its light weight and small size. This paper gives an overview of the therapeutic options and the clinical results of treating fractures of the proximal interphalangeal joint.
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Affiliation(s)
- E Goldberg
- Plastisch- und Handchirurgische Klinik, Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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Desai N, AbdelHafez F, Goldberg E, Chase R, Karode M. Evaluation of sperm DNA fragmentation using the Halo sperm kit. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.07.1217] [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: 10/20/2022]
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Slifer K, Amarian M, Auerbach L, Averett T, Berthot J, Bertin P, Bertozzi B, Black T, Brash E, Brown D, Burtin E, Calarco J, Cates G, Chai Z, Chen JP, Choi S, Chudakov E, Ciofi Degli Atti C, Cisbani E, de Jager CW, Deur A, DiSalvo R, Dieterich S, Djawotho P, Finn M, Fissum K, Fonvieille H, Frullani S, Gao H, Gao J, Garibaldi F, Gasparian A, Gilad S, Gilman R, Glamazdin A, Glashausser C, Glöckle W, Golak J, Goldberg E, Gomez J, Gorbenko V, Hansen JO, Hersman B, Holmes R, Huber GM, Hughes E, Humensky B, Incerti S, Iodice M, Jensen S, Jiang X, Jones C, Jones G, Jones M, Jutier C, Kamada H, Ketikyan A, Kominis I, Korsch W, Kramer K, Kumar K, Kumbartzki G, Kuss M, Lakuriqi E, Laveissiere G, Lerose JJ, Liang M, Liyanage N, Lolos G, Malov S, Marroncle J, McCormick K, McKeown RD, Meziani ZE, Michaels R, Mitchell J, Nogga A, Pace E, Papandreou Z, Pavlin T, Petratos GG, Pripstein D, Prout D, Ransome R, Roblin Y, Rowntree D, Rvachev M, Sabatié F, Saha A, Salmè G, Scopetta S, Skibiński R, Souder P, Saito T, Strauch S, Suleiman R, Takahashi K, Teijiro S, Todor L, Tsubota H, Ueno H, Urciuoli G, Van der Meer R, Vernin P, Voskanian H, Witała H, Wojtsekhowski B, Xiong F, Xu W, Yang JC, Zhang B, Zolnierczuk P. 3He spin-dependent cross sections and sum rules. Phys Rev Lett 2008; 101:022303. [PMID: 18764175 DOI: 10.1103/physrevlett.101.022303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Indexed: 05/26/2023]
Abstract
We present a measurement of the spin-dependent cross sections for the 3He over -->(e over -->,e')X reaction in the quasielastic and resonance regions at a four-momentum transfer 0.1< or =Q2< or =0.9 GeV2. The spin-structure functions have been extracted and used to evaluate the nuclear Burkhardt-Cottingham and extended Gerasimov-Drell-Hearn sum rules for the first time. The data are also compared to an impulse approximation calculation and an exact three-body Faddeev calculation in the quasielastic region.
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Affiliation(s)
- K Slifer
- Temple University, Philadelphia, Pennsylvania 19122, USA
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Paul M, Nielsen AD, Gafter-Gvili A, Tacconelli E, Andreassen S, Almanasreh N, Goldberg E, Cauda R, Frank U, Leibovici L. The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis. Eur Respir J 2007; 30:525-31. [PMID: 17537772 DOI: 10.1183/09031936.00031007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present study compared beta-lactam macrolide ("combination") therapy versus beta-lactam alone ("monotherapy") for hospitalised community-acquired pneumonia, using propensity scores to adjust for the differences between patients. A prospective multinational observational study was carried out. Baseline patient and infection characteristics were used to develop a propensity score for combination therapy. Patients were matched by the propensity score (three decimal point precision) and compared with 30-day mortality and hospital stay. The propensity score was used as a covariate in a logistic model for mortality. Patients treated with monotherapy (n = 169) were older (mean+/-sd age 70.6+/-17.3 versus 65.0+/-19.6 yrs), had a higher chronic diseases score and a different clinical presentation compared with patients treated with combination therapy (n = 282). Unadjusted mortality was significantly higher with monotherapy (37 (22%) out of 169 versus 21 (7%) out of 282). Only 27 patients in the monotherapy group could be matched to 27 patients in the combination group using the propensity score. The mortality in these groups was identical, with three (11%) demises each. The multivariable odds ratio for mortality associated with combination therapy, adjusted for the propensity score and the Pneumonia Severity Index, was 0.69 (95% confidence interval 0.32-1.48). The benefit of combination therapy versus monotherapy cannot be reliably assessed in observational studies, since the propensity to prescribe these regimens differs markedly.
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Affiliation(s)
- M Paul
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, 49100 Petah-Tiqva, Israel
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Abstract
BACKGROUND Two typhoid vaccines are commercially available, Ty21a (oral) and Vi polysaccharide (parenteral), but neither is used routinely. Other vaccines, such as a new modified, conjugated Vi vaccine called Vi-rEPA, are in development. OBJECTIVES To evaluate vaccines for preventing typhoid fever. SEARCH STRATEGY In December 2006, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2006, Issue 3), MEDLINE, EMBASE, LILACS, and mRCT. We also searched relevant conference proceedings up to 2004 and scanned the reference lists of all included trials. SELECTION CRITERIA Randomized and quasi-randomized controlled trials (RCTs) comparing typhoid fever vaccines with other typhoid fever vaccines or an inactive agent (placebo or vaccine for a different disease). DATA COLLECTION AND ANALYSIS Two authors independently applied inclusion criteria and extracted data. We computed vaccine efficacy per year of follow up and cumulative three-year efficacy, stratifying for vaccine type and dose. We calculated relative risks (RR) and efficacy (1-RR as a percentage) with 95% confidence intervals (CI). MAIN RESULTS Of the 17 included RCTs, 10 evaluated efficacy (Ty21a: 5 trials; Vi polysaccharide: 4 trials, Vi-rEPA: 1 trial), and 11 reported on adverse events.Ty21a vaccine (3 doses). According to one trial (20,543 participants), this vaccine provided statistically significant protection in each of the first three years (one: 35%, 95% CI 8% to 54%; two: 58%, 95% CI 40% to 71%; three: 46%, 95% CI -6% to 72%), and the cumulative efficacy for 2.5 to 3 years was 48% (95% CI 34% to 58%). Four cluster-RCTs that did not adjust for clustering were not included in the meta-analyses. Compared with placebo, this vaccine was not associated with an increased rate of fever, vomiting, diarrhoea, nausea or abdominal pain, headache, or rash.Vi polysaccharide vaccine (1 dose). This vaccine provided protection in year one (68%, 95% CI 50% to 80%; 99,979 participants, 3 trials) and year two (60%, 95% CI 31% to 76%; 142,555 participants, 2 trials), but not in year three (11,384 participants, 1 trial). The three-year cumulative efficacy was 55% (95% CI 30% to 70%; 11,384 participants, 1 trial). Compared with placebo, there was no statistically significant difference in the incidence of fever or erythema, but local swelling was more common with the vaccine.Vi-rEPA vaccine (2 doses). In one trial of 12,008 participants, this vaccine provided protection in year one (94%, 95% CI 75% to 99%) and year two (87%, 95% CI 56% to 96%). Cumulative efficacy at 46 months (3.8 years) was 89% (95% CI 76% to 97%). No swelling or erythema occurred in the vaccine or placebo group; fever was more frequent in the vaccine group. AUTHORS' CONCLUSIONS The licensed Ty21a and Vi polysaccharide vaccines are efficacious. The new and unlicensed Vi-rEPA vaccine is as efficacious and may confer longer immunity.
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Affiliation(s)
- A Fraser
- University of Bristol, Canynge Hall, Department of Social Medicine, Whiteladies Road, Bristol, UK, BS8 2PR.
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Goldberg E, Gafter-Gvili A, Paul M, Robenshtok E, Vidal L, Leibovici L. P963 Empirical antifungal therapy in febrile neutropenic patients-systematic review. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Druckrey-Fiskaaen KT, Janssen MWW, Omidi L, Polze N, Kaisers U, Nur I, Goldberg E, Bokel G, Hauss J, Schön MR. Laparoscopic spray application of fibrin sealant effects on hemodynamics and spray efficiency at various application pressures and distances. Surg Endosc 2007; 21:1750-9. [PMID: 17318690 DOI: 10.1007/s00464-007-9235-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 11/07/2006] [Accepted: 11/25/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laparoscopic resections of parenchymal organs are increasingly performed. However, little is known about the effects of laparoscopic fibrin sealant spray applications on intraabdominal pressure (IAP) and hemodynamics. METHODS Cardiac and pulmonary monitoring was performed via two central venous pressure lines in the thoracic and abdominal vena cava, a pulmonary artery catheter, and a peripheral artery line. Air was sprayed into the abdomen at pressures of 2, 3, and 4 bar for 30 s. According to the group, a valve on a trocar was open or closed. To optimize fibrin sealant application, the sealant was sprayed at three different application pressures (2, 2.5, and 3 bar) and distances (2, 3.5, and 5 cm). RESULTS All spray simulations caused a significant increase in the IAP. During the first 10 s of spraying, the IAP increase was 5 mmHg or less, but rose rapidly during the last 20 s of spraying. The IAP increase resulted in decreased pulmonary compliance. Pulmonary resistance and the central venous pressures of both the thoracic and abdominal vena cava increased. At application pressures of 3 and 4 bar, the IAP increase was greater than 2 bar of pressure, reaching IAP values exceeding 35 mmHg. Spray mist formation was primarily dependent on application pressure, whereas clot formation and surface coverage depended on both application pressure and distance. The best results were achieved with an application pressure of 2.5 bar and a distance of 5 cm from the surface. CONCLUSIONS This study shows that fibrin sealants can be used safely in laparoscopic procedures. Keeping the spray periods short and allowing air to escape from the abdomen can minimize the IAP increase. According to our results, a laparoscopic spray application of fibrin sealant should start with an insufflation pressure of 10 mmHg, an application pressure of 2.5 bar, and an application distance of 5 cm with a valve on the trocar left open.
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Affiliation(s)
- K T Druckrey-Fiskaaen
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, Universität Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Frantz S, Behr T, Hu K, Fraccarollo D, Strotmann J, Goldberg E, Ertl G, Angermann CE, Bauersachs J. Role of p38 mitogen-activated protein kinase in cardiac remodelling. Br J Pharmacol 2006; 150:130-5. [PMID: 17179956 PMCID: PMC2042905 DOI: 10.1038/sj.bjp.0706963] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND PURPOSE Mitogen-activated protein kinases (MAPK) are centrally involved in several mechanisms important for heart failure such as apoptosis, activation of inflammatory responses and cell proliferation. We therefore evaluated the effect of the selective p38 MAPK inhibitor SB 239063 on progression of left ventricular remodelling after myocardial infarction (MI) in rats. EXPERIMENTAL APPROACH Rats were treated for 9 weeks with placebo or SB 239063 by gavage (15 mg kg(-1)) twice daily starting 7 days after ligation of the left anterior descending artery. Serial transthoracic echocardiography was performed at days 7, 36 and 70. KEY RESULTS Over the 9 weeks, mortality was not different between the groups. On echocardiography, animals after myocardial infarction exhibited significant left ventricular dilatation as expected (week 10, end-systolic diameter, placebo sham 5.21+/- 0.34 vs. placebo MI 8.44+/- 0.57 mm). However, there was no difference between placebo and SB 239063-treated rats (week 10, end-systolic diameter, SB MI 7.76+/- 0.74 mm, not significantly different from placebo MI). Haemodynamics changed accordingly. Moreover, SB 239063 had no effect on left ventricular hypertrophy. Treatment with SB 239063 significantly reduced cytokine expression of tumour necrosis factor and interleukin-1beta after myocardial infarction. However, collagen content was not influenced by the treatment. CONCLUSION Despite a reduction of inflammation, treatment with the p38 inhibitor SB 239063 does not affect cardiac remodelling and cardiac function when treatment is started 7 days after myocardial infarction.
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Affiliation(s)
- S Frantz
- Medizinische Klinik und Poliklinik I, Herz-/ Kreislaufzentrum, Universität Würzburg, Germany.
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Amarian M, Auerbach L, Averett T, Berthot J, Bertin P, Bertozzi W, Black T, Brash E, Brown D, Burtin E, Calarco J, Cates G, Chai Z, Chen JP, Choi S, Chudakov E, Cisbani E, de Jager CW, Deur A, DiSalvo R, Dieterich S, Djawotho P, Finn JM, Fissum K, Fonvieille H, Frullani S, Gao H, Gao J, Garibaldi F, Gasparian A, Gilad S, Gilman R, Glamazdin A, Glashausser C, Goldberg E, Gomez J, Gorbenko V, Hansen JO, Hersman B, Holmes R, Huber GM, Hughes E, Humensky B, Incerti S, Iodice M, Jensen S, Jiang X, Jones C, Jones G, Jones M, Jutier C, Ketikyan A, Kominis I, Korsch W, Kramer K, Kumar K, Kumbartzki G, Kuss M, Lakuriqi E, Laveissiere G, Lerose J, Liang M, Liyanage N, Lolos G, Malov S, Marroncle J, McCormick K, McKeown R, Meziani ZE, Michaels R, Mitchell J, Papandreou Z, Pavlin T, Petratos GG, Pripstein D, Prout D, Ransome R, Roblin Y, Rowntree D, Rvachev M, Sabatie F, Saha A, Slifer K, Souder P, Saito T, Strauch S, Suleiman R, Takahashi K, Teijiro S, Todor L, Tsubota H, Ueno H, Urciuoli G, Van der Meer R, Vernin P, Voskanian H, Wojtsekhowski B, Xiong F, Xu W, Yang JC, Zhang B, Zołnierczuk PA. Measurement of the generalized forward spin polarizabilities of the neutron. Phys Rev Lett 2004; 93:152301. [PMID: 15524867 DOI: 10.1103/physrevlett.93.152301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Indexed: 05/24/2023]
Abstract
The generalized forward spin polarizabilities gamma(0) and delta(LT) of the neutron have been extracted for the first time in a Q2 range from 0.1 to 0.9 GeV2. Since gamma(0) is sensitive to nucleon resonances and delta(LT) is insensitive to the Delta resonance, it is expected that the pair of forward spin polarizabilities should provide benchmark tests of the current understanding of the chiral dynamics of QCD. The new results on delta(LT) show significant disagreement with chiral perturbation theory calculations, while the data for gamma(0) at low Q2 are in good agreement with a next-to-leading-order relativistic baryon chiral perturbation theory calculation. The data show good agreement with the phenomenological MAID model.
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Affiliation(s)
- M Amarian
- Yerevan Physics Institute, Yerevan 375036, Armenia
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Duan C, Goldberg E. Inhibition of lactate dehydrogenase C4 (LDH-C4) blocks capacitation of mouse sperm in vitro. Cytogenet Genome Res 2004; 103:352-9. [PMID: 15051959 DOI: 10.1159/000076824] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2003] [Accepted: 12/09/2003] [Indexed: 11/19/2022] Open
Abstract
Lactate dehydrogenase C4 (LDH-C4) is a tissue-specific enzyme in the mammalian testis and the only lactate dehydrogenase isozyme of sperm. Inhibitors of LDH activity were used to determine whether this enzyme plays a role in sperm capacitation, the acrosome reaction and/or fertilization. Oxamate or its derivative was used to inhibit sperm LDH activity in a medium promoting capacitation. Complete inhibition of LDH activity blocked capacitation. This effect could be reversed partially by the addition of dbcAMP or pentoxifylline to the culture medium. Western blotting showed that oxamate and N-isopropyl oxamate inhibited the tyrosine phosphorylation of proteins during the sperm capacitation process. Presumably, glycolysis is the primary energy pathway for sperm metabolism. The oxidation of reduced NAD with the conversion of pyruvate to lactate by LDH provides ATP necessary for protein kinase A (PKA) activity. Our data indicate that LDH-C4 plays an important metabolic role in sperm capacitation.
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Affiliation(s)
- C Duan
- Department of Biochemistry, Molecular Biology and Cell Biology, Northwestern University, Evanston, IL 60208, USA
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Amarian M, Auerbach L, Averett T, Berthot J, Bertin P, Bertozzi B, Black T, Brash E, Brown D, Burtin E, Calarco J, Cates G, Chai Z, Chen JP, Choi S, Chudakov E, Cisbani E, De Jager CW, Deur A, DiSalvo R, Dieterich S, Djawotho P, Finn M, Fissum K, Fonvieille H, Frullani S, Gao H, Gao J, Garibaldi F, Gasparian A, Gilad S, Gilman R, Glamazdin A, Glashausser C, Goldberg E, Gomez J, Gorbenko V, Hansen JO, Hersman B, Holmes R, Huber GM, Hughes E, Humensky B, Incerti S, Iodice M, Jensen S, Jiang X, Jones C, Jones G, Jones M, Jutier C, Ketikyan A, Kominis I, Korsch W, Kramer K, Kumar K, Kumbartzki G, Kuss M, Lakuriqi E, Laveissiere G, Lerose J, Liang M, Liyanage N, Lolos G, Malov S, Marroncle J, McCormick K, McKeown R, Meziani ZE, Michaels R, Mitchell J, Papandreou Z, Pavlin T, Petratos GG, Pripstein D, Prout D, Ransome R, Roblin Y, Rowntree D, Rvachev M, Sabatie F, Saha A, Slifer K, Souder P, Saito T, Strauch S, Suleiman R, Takahashi K, Teijiro S, Todor L, Tsubota H, Ueno H, Urciuoli G, Van Der Meer R, Vernin P, Voskanian H, Wojtsekhowski B, Xiong F, Xu W, Yang JC, Zhang B, Zolnierczuk P. Q2 evolution of the neutron spin structure moments using a 3He target. Phys Rev Lett 2004; 92:022301. [PMID: 14753931 DOI: 10.1103/physrevlett.92.022301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Indexed: 05/24/2023]
Abstract
We have measured the spin structure functions g(1) and g(2) of 3He in a double-spin experiment by inclusively scattering polarized electrons at energies ranging from 0.862 to 5.058 GeV off a polarized 3He target at a 15.5 degrees scattering angle. Excitation energies covered the resonance and the onset of the deep inelastic regions. We have determined for the first time the Q2 evolution of Gamma(1)(Q2)= integral (1)(0)g(1)(x,Q2)dx, Gamma(2)(Q2)= integral (1)(0)g(2)(x,Q2)dx, and d(2)(Q2)= integral (1)(0)x(2)[2g(1)(x,Q2)+3g(2)(x,Q2)]dx for the neutron in the range 0.1< or =Q2< or =0.9 GeV2 with good precision. Gamma(1)(Q2) displays a smooth variation from high to low Q2. The Burkhardt-Cottingham sum rule holds within uncertainties and d(2) is nonzero over the measured range.
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Affiliation(s)
- M Amarian
- Yerevan Physics Institute, Yerevan 375036, Armenia
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