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Stern R, Pena H, Tart D, Dunn C, Kester K. Implementation and Evaluation of a Digital Debriefing Tool for Significant Events. J Nurs Care Qual 2024; 39:4-6. [PMID: 37350579 DOI: 10.1097/ncq.0000000000000728] [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: 06/24/2023]
Affiliation(s)
- Robert Stern
- Duke University Hospital, Durham, North Carolina
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Weerasuriya S, Chen J, Peltier M, Ambalu N, Stern R. Medical Student Social Calls to Isolated Older Adults: A Pilot Study. The American Journal of Geriatric Psychiatry 2023. [PMCID: PMC9934895 DOI: 10.1016/j.jagp.2022.12.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Tsai FD, Guercio B, Stuver S, Stern R, Peluso MJ, Winkler M, Piawah S, Vallurupalli M, Luskin MR, Braun D, Parent A, Glotzbecker B, Kilbridge KL. Resident-Reported Impact of a Novel Oncology Curriculum for Internal Medicine Residents. J Cancer Educ 2022; 37:1879-1885. [PMID: 34480712 PMCID: PMC8417651 DOI: 10.1007/s13187-021-02055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
The Accreditation Council of Graduate Medical Education mandates that all internal medicine residents gain exposure to internal medicine subspecialties including hematology and oncology. While many residents meet this criterion through inpatient oncology rotations, the current structure of many inpatient oncology rotations leaves little opportunity for formal education. We therefore designed a novel oncology curriculum consisting of one-page oncology teaching sheets to increase the number, breadth, and quality of formal teaching sessions on our resident inpatient oncology services. In order to evaluate the curriculum, we conducted pre- and post-intervention surveys of residents. From these surveys, we found that 72.2% of residents used the teaching sheets on their inpatient oncology rotation and that the teaching sheets led to an increase in the number of formal oncology teaching sessions (mean 3.4 ± 2.1 post-implementation vs 2.6 ± 2.0 pre-implementation, p = 0.008), the breadth of oncology topics taught (% reporting ≥ 5 topics; 26.1% vs 16.3%, p = 0.035), the proportion of residents reporting improvement in overall oncology knowledge (80.2% vs 62.4%, p = 0.012), and the proportion of residents reporting improvement in their ability to care for patients (70.8% vs 48.9%, p = 0.013). These results demonstrate that formal oncology teaching can be improved on inpatient oncology rotations through a simple and easily replicable oncology curriculum.
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Affiliation(s)
- Frederick D Tsai
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Brendan Guercio
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sherri Stuver
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Boston University School of Public Health, Boston University, Boston, MA, 02118, USA
| | - Robert Stern
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Michael J Peluso
- University of California San Francisco Medical Center, San Francisco, CA, 94143, USA
| | | | - Sorbarikor Piawah
- University of California San Francisco Medical Center, San Francisco, CA, 94143, USA
| | - Mounica Vallurupalli
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Marlise R Luskin
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - David Braun
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Alexander Parent
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Brett Glotzbecker
- University Hospital Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Kerry Laing Kilbridge
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
- Brigham & Women's Hospital, Boston, MA, 02115, USA.
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
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Frank B, Ally M, Tripodis Y, Puzo C, Labriolo C, Hurley L, Martin B, Palmisano J, Chan L, Steinberg E, Turk K, Budson A, O’Connor M, Au R, Qiu WQ, Goldstein L, Kukull W, Kowall N, Killiany R, Stern R, Stein T, McKee A, Mez J, Alosco M. Trajectories of Cognitive Decline in Brain Donors With Autopsy-Confirmed Alzheimer Disease and Cerebrovascular Disease. Neurology 2022; 98:e2454-e2464. [PMID: 35444054 PMCID: PMC9231841 DOI: 10.1212/wnl.0000000000200304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/16/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebrovascular disease (CBVD) is frequently comorbid with autopsy-confirmed Alzheimer disease (AD), but its contribution to the clinical presentation of AD remains unclear. We leveraged the National Alzheimer's Coordinating Center (NACC) uniform and neuropathology datasets to compare the cognitive and functional trajectories of AD+/CBVD+ and AD+/CBVD- brain donors. METHODS The sample included NACC brain donors with autopsy-confirmed AD (Braak stage ≥3, Consortium to Establish a Registry for Alzheimer's Disease score ≥2) and complete Uniform Data Set (UDS) evaluations between 2005 and 2019, with the most recent UDS evaluation within 2 years of autopsy. CBVD was defined as moderate to severe arteriosclerosis or atherosclerosis. We used propensity score weighting to isolate the effects of comorbid AD and CBVD. This method improved the balance of covariates between the AD+/CBVD+ and AD+/CBVD- groups. Longitudinal mixed-effects models were assessed with robust bayesian estimation. UDS neuropsychological test and the Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) scores were primary outcomes. RESULTS Of 2,423 brain donors, 1,476 were classified as AD+/CBVD+. Compared with AD+/CVBD- donors, the AD+/CBVD+ group had accelerated decline (i.e., group × time effects) on measures of processing speed (β = -0.93, 95% CI -1.35, -0.51, Bayes factor [BF] 130.75), working memory (β = 0.05, 95% CI 0.02, 0.07, BF 3.59), verbal fluency (β = 0.10, 95% CI 0.04, 0.15, BF 1.28), naming (β = 0.09, 95% CI 0.03, 0.16, BF = 0.69), and CDR-SB (β = -0.08, 95% CI -0.12, -0.05, BF 18.11). Effects ranged from weak (BFs <3.0) to strong (BFs <150). We also found worse performance in the AD+/CBVD+ group across time on naming (β = -1.04, 95% CI -1.83, -0.25, BF 2.52) and verbal fluency (β = -0.73, 95% CI -1.30, -0.15, BF 1.34) and more impaired CDR-SB scores (β = 0.45, 95% CI 0.01, 0.89, BF 0.33). DISCUSSION In brain donors with autopsy-confirmed AD, comorbid CBVD was associated with an accelerated functional and cognitive decline, particularly on neuropsychological tests of attention, psychomotor speed, and working memory. CBVD magnified effects of AD neuropathology on semantic-related neuropsychological tasks. Findings support a prominent additive and more subtle synergistic effect for comorbid CBVD neuropathology in AD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michael Alosco
- From the Boston University Alzheimer's Disease Center and CTE Center (B.F., M. Ally, Y.T., C.P., C.L., B.M., J.P., L.C., E.S., K.T., A.B., M.O., R.A., W.Q.Q., L.G., N.K., R.K., R.S., T.S., A.M., J.M., M. Alosco), Boston University School of Medicine; Veteran Affairs Bedford Healthcare System (B.F., M.O., T.S., A.M.), Bedford; Department of Biostatistics (Y.T.), Boston University School of Public Health, MA; Yale School of Public Health (L.H.), New Haven, CT; Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Department of Neurology (K.T., A.B., R.A., N.K., R.S., A.M., J.M., M. Alosco), Boston University School of Medicine; Veterans Affairs Boston Healthcare System (K.T., A.B., N.K., T.S., A.M); Department of Anatomy & Neurobiology (R.A., R.K., R.S.), Boston University School of Medicine; MA; Framingham Heart Study (R.A.), National Heart, Lung, and Blood Institute, Bethesda, MD; Department of Epidemiology (R.A.), Boston University School of Public Health; Department of Psychiatry (W.Q.Q.), Boston University School of Medicine; Department of Pharmacology & Experimental Therapeutics (W.Q.Q.), Boston University School of Medicine; Department of Pathology and Laboratory Medicine (L.G.), Boston University School of Medicine; Departments of Psychiatry and Ophthalmology (L.G.), Boston University School of Medicine; Departments of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering, MA; National Alzheimer's Coordinating Center (W.K.), Department of Epidemiology, University of Washington, Seattle; Center for Biomedical Imaging (R.K.), and Boston University School of Medicine; Department of Neurosurgery (R.S.), Boston University School of Medicine, MA.
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Prelog M, Almanzar G, Stern R, Robrade K, Holzer MT, Winzig C, Kleines M, Stiasny K, Meyer T, Speth F, Haas JP. Humoral and cellular immune response to tick-borne-encephalitis (TBE) vaccination depends on booster doses in patients with Juvenile Idiopathic Arthritis (JIA). Vaccine 2021; 39:5918-5927. [PMID: 34462165 DOI: 10.1016/j.vaccine.2021.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/02/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/15/2022]
Abstract
Juvenile Idiopathic Arthritis (JIA) patients living in areas with high prevalence of tick-borne-encephalitis-virus-(TBEV)-infection are recommended for administration of inactivated TBE-vaccination. However, there are serious concerns regarding protective vaccine-induced immune responses against TBEV in immunocompromised patients. The present study aimed to analyze the humoral and cellular immune response to TBE-vaccination in previously TBE-vaccinated JIA patients compared to healthy controls (HC) including investigation of IgG-anti-TBEV avidity, neutralization capacity, cellular reactivity by IFNgamma-ELISPOT and cytokine secretion assays. Similar IgG-anti-TBEV antibody concentrations, neutralization titers and cellular reactivity were found between JIA and HC. The number and the early timing of booster vaccinations after primary vaccination had the most prominent effect on neutralizing antibodies in JIA and on IgG-anti-TBEV concentrations in both JIA and HC. Administration of booster vaccinations made it more likely for JIA patients to have IgG-anti-TBEV concentrations ≥165 VIEU/ml and avidities >60%. TNF-alpha inhibitors had a positive and MTX administration a negative effect on humoral immune responses. In conclusion, irrespective of having JIA or not, vaccinated children showed similar humoral and cellular immunity against TBEV several years after primary TBE-vaccination. However, in JIA, booster vaccinations mounted a significantly higher humoral immune response than in JIA without boosters. Our results highlight the need for timely administration of boosters particularly in JIA. Although immunosuppressive treatment at vaccinations in diagnosed JIA had a negative effect mainly on TBEV-specific cellular immunity, most JIA patients mounted a favorable humoral immune response which was maintained over time. Thus, successful TBE-vaccination seems highly feasible in JIA patients with immunosuppressive regimens.
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Affiliation(s)
- M Prelog
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany.
| | - G Almanzar
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - R Stern
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - K Robrade
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - M T Holzer
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - C Winzig
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - M Kleines
- Department of Medical Microbiology, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - K Stiasny
- Department of Virology, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - T Meyer
- Pediatric Surgery Unit, Department of Surgery, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - F Speth
- German Center of Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467 Garmisch-Partenkirchen, Germany
| | - J P Haas
- German Center of Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467 Garmisch-Partenkirchen, Germany
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Abstract
Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality-notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.
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Affiliation(s)
- Megan Buresh
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Stern
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Darius Rastegar
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Le-Thai C, Guiddir T, Stern R, Smilov M, Pigeot JC, Merzouk A, Billard-Larue C, de Menibus AC, Nemni A. Impact du confinement sur le suivi des immunothérapies orales alimentaires : étude multicentrique dans 3 centres d’Île-de-France. Revue Française d'Allergologie 2021; 61:75-80. [PMID: 33354251 PMCID: PMC7746089 DOI: 10.1016/j.reval.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/12/2020] [Indexed: 12/05/2022]
Abstract
But de l’étude Plusieurs études ont confirmé l’impact du confinement sur la population, entraînant une rupture de soins, des effets somatiques et psychologiques. Notre étude s’intéresse aux effets indésirables et aux problèmes d’observance au cours d’immunothérapie orale (ITO) alimentaires pendant le confinement. Patients et méthodes Au total, 132 patients, majoritairement des enfants (95 %), avec un antécédent atopique (60 %) suivis pour une ITO ont été inclus dans 3 centres d’allergologie en Île-de-France, pendant le confinement lié à la pandémie SARS-Cov-2 du 16/03 au 11/05/20. Les aliments des ITO étaient principalement l’arachide (38 %), le lait de vache (24 %), la noisette (14 %), l’œuf (9 %), la noix de cajou et la pistache (8 %). Résultats Des effets indésirables ont été retrouvés chez 13 patients soit 10 % des cas. Ces réactions étaient principalement de grade 1 et 2 selon la classification de Ring et Messmer. Trois patients ont présenté des réactions de grade 3 et six patients ont utilisé l’adrénaline au domicile. L’observance était correcte dans 81 % des cas sans aucun oubli. Trois patients ont augmenté leur dose quotidienne sans avis médical. Nous n’avons pas retrouvé de différence significative dans l’analyse en sous-groupe comparant des enfants appariés en âge suivis en ITO en 2019 et en 2020 sur la même période dans le même hôpital. Conclusion Il n’y a pas eu d’augmentation des effets indésirables au cours d’ITO pendant la période du confinement. L’éducation thérapeutique au cours de l’ITO est primordiale et participe à réduire la survenue d’effets indésirables.
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Affiliation(s)
- C Le-Thai
- Unité d'allergologie enfants-adultes, centre hospitalier intercommunal Robert-Ballanger, boulevard Robert-Ballanger, 93600 Aulnay-sous-Bois, France
| | - T Guiddir
- Service de pédiatrie générale, centre hospitalier universitaire Bicêtre, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - R Stern
- Unité d'allergologie enfants-adultes, centre hospitalier intercommunal Robert-Ballanger, boulevard Robert-Ballanger, 93600 Aulnay-sous-Bois, France
| | - M Smilov
- Unité d'allergologie enfants-adultes, centre hospitalier intercommunal Robert-Ballanger, boulevard Robert-Ballanger, 93600 Aulnay-sous-Bois, France
| | - J-C Pigeot
- Unité d'allergologie enfants-adultes, centre hospitalier intercommunal Robert-Ballanger, boulevard Robert-Ballanger, 93600 Aulnay-sous-Bois, France
| | - A Merzouk
- Unité d'allergologie enfants-adultes, centre hospitalier intercommunal Robert-Ballanger, boulevard Robert-Ballanger, 93600 Aulnay-sous-Bois, France
| | - C Billard-Larue
- Unité d'allergologie enfants-adultes, grand hôpital de l'Est Francilien - site de Meaux, 6, rue Saint-Fiacre, 77100 Meaux, France
| | - A-C de Menibus
- Unité d'allergologie enfants-adultes, centre hospitalier intercommunal Robert-Ballanger, boulevard Robert-Ballanger, 93600 Aulnay-sous-Bois, France
- Unité d'allergologie enfants-adultes, grand hôpital de l'Est Francilien - site de Meaux, 6, rue Saint-Fiacre, 77100 Meaux, France
| | - A Nemni
- Unité d'allergologie enfants-adultes, centre hospitalier intercommunal Robert-Ballanger, boulevard Robert-Ballanger, 93600 Aulnay-sous-Bois, France
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Zajac L, Koo BB, Tripodis Y, Mian A, Steinberg E, Mez J, Alosco ML, Cervantes-Arslanian A, Stern R, Killiany R. Hippocampal Resting-State Functional Connectivity Patterns are More Closely Associated with Severity of Subjective Memory Decline than Whole Hippocampal and Subfield Volumes. Cereb Cortex Commun 2020; 1:tgaa019. [PMID: 32905008 PMCID: PMC7463163 DOI: 10.1093/texcom/tgaa019] [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: 04/03/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/02/2022] Open
Abstract
The goal of this study was to examine whether hippocampal volume or resting-state functional connectivity (rsFC) patterns are associated with subjective memory decline (SMD) in cognitively normal aged adults. Magnetic resonance imaging data from 53 participants (mean age: 71.9 years) of the Boston University Alzheimer’s Disease Center registry were used in this cross-sectional study. Separate analyses treating SMD as a binary and continuous variable were performed. Subfield volumes were generated using FreeSurfer v6.0, and rsFC strength between the head and body of the hippocampus and the rest of the brain was calculated. Decreased left whole hippocampal volume and weaker rsFC strength between the right body of the hippocampus and the default mode network (DMN) were found in SMD+. Cognitive Change Index score was not correlated with volumetric measures but was inversely correlated with rsFC strength between the right body of the hippocampus and 6 brain networks, including the DMN, task control, and attentional networks. These findings suggest that hippocampal rsFC patterns reflect the current state of SMD in cognitively normal adults and may reflect subtle memory changes that standard neuropsychological tests are unable to capture.
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Affiliation(s)
- Lauren Zajac
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Bang-Bon Koo
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA 02118, USA
| | - Asim Mian
- Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Eric Steinberg
- Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA 02118, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA 02118, USA
| | | | - Robert Stern
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Ronald Killiany
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
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Carroll JE, Small BJ, Tometich D, Zhai W, Zhou X, Luta G, Ahles TA, Saykin AJ, Nudelman KNH, Clapp JD, Jim H, Jacobsen PB, Hurria A, Graham D, McDonald BC, Denduluri N, Extermann M, Isaacs C, Dilawari AA, Root J, Stern R, Mandelblatt JS. Sleep disturbance and neurocognitive outcomes in older patients with breast cancer: Interaction with genotype. Cancer 2019; 125:4516-4524. [PMID: 31553501 PMCID: PMC6891125 DOI: 10.1002/cncr.32489] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/03/2019] [Accepted: 07/09/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sleep disturbance and genetic profile are risks for cognitive decline in noncancer populations, yet their role in cancer-related cognitive problems remains understudied. This study examined whether sleep disturbance was associated with worse neurocognitive outcomes in breast cancer survivors and whether sleep effects on cognition varied by genotype. METHODS Newly diagnosed female patients (n = 319) who were 60 years old or older and had stage 0 to III breast cancer were recruited from August 2010 to December 2015. Assessments were performed before systemic therapy and 12 and 24 months later. Neuropsychological testing measured attention, processing speed, executive function, learning, and memory; self-perceived cognitive functioning was also assessed. Sleep disturbance was defined by self-report of routine poor or restless sleep. Genotyping included APOE, BDNF, and COMT polymorphisms. Random effects fluctuation models tested associations of between-person and within-person differences in sleep, genotype, and sleep-genotype interactions and cognition and controlled for age, reading level, race, site, and treatment. RESULTS One-third of the patients reported sleep disturbances at each time point. There was a sleep-APOE ε4 interaction (P = .001) in which patients with the APOE ε4 allele and sleep disturbances had significantly lower learning and memory scores than those who were APOE ε4-negative and without sleep disturbances. There was also a sleep disturbance-COMT genotype interaction (P = .02) in which COMT Val carriers with sleep disturbances had lower perceived cognition than noncarriers. CONCLUSIONS Sleep disturbance was common and was associated with worse cognitive performance in older breast cancer survivors, especially those with a genetic risk for cognitive decline. Survivorship care should include sleep assessments and interventions to address sleep problems.
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Affiliation(s)
- Judith E. Carroll
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, UCLA Cousins Center for PNI, Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | | | | | - Wanting Zhai
- Lombardi Comprehensive Cancer Center, Georgetown University
| | - Xiangtao Zhou
- Lombardi Comprehensive Cancer Center, Georgetown University
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University
| | - Tim A. Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J. Saykin
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Kelly N. H. Nudelman
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | - Paul B. Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD
| | | | | | - Brenna C. McDonald
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | - James Root
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Stern
- Boston University School of Medicine, Boston University
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Eberly LA, Richterman A, Beckett AG, Wispelwey B, Marsh RH, Cleveland Manchanda EC, Chang CY, Glynn RJ, Brooks KC, Boxer R, Kakoza R, Goldsmith J, Loscalzo J, Morse M, Lewis EF, Abel S, Adams A, Anaya J, Andrews EH, Atkinson B, Avutu V, Bachorik A, Badri O, Bailey M, Baird K, Bakshi S, Balaban D, Barshop K, Baumrin E, Bayomy O, Beamesderfer J, Becker N, Berg DD, Berman AN, Blum SM, Boardman AP, Boden K, Bonacci RA, Brown S, Campbell K, Case S, Cetrone E, Charrow A, Chiang D, Clark D, Cohen AJ, Cooper A, Cordova T, Cuneo CN, de Feria AA, Deffenbacher K, DeFilippis EM, DeGregorio G, Deutsch AJ, Diephuis B, Divakaran S, Dorschner P, Downing N, Drescher C, D'Silva KM, Dunbar P, Duong D, Earp S, Eckhardt C, Elman SA, England R, Everett K, Fedotova N, Feingold-Link T, Ferreira M, Fisher H, Foo P, Foote M, Franco I, Gilliland T, Greb J, Greco K, Grewal S, Grin B, Growdon ME, Guercio B, Hahn CK, Hasselfeld B, Haydu EJ, Hermes Z, Hildick-Smith G, Holcomb Z, Holroyd K, Horton L, Huang G, Jablonski S, Jacobs D, Jain N, Japa S, Joseph R, Kalashnikova M, Kalwani N, Kang D, Karan A, Katz JT, Kellner D, Kidia K, Kim JH, Knowles SM, Kolbe L, Kore I, Koullias Y, Kuye I, Lang J, Lawlor M, Lechner MG, Lee K, Lee S, Lee Z, Limaye N, Lin-Beckford S, Lipsyc M, Little J, Loewenthal J, Logaraj R, Lopez DM, Loriaux D, Lu Y, Ma K, Marukian N, Matias W, Mayers JR, McConnell I, McLaughlin M, Meade C, Meador C, Mehta A, Messenger E, Michaelidis C, Mirsky J, Mitten E, Mueller A, Mullur J, Munir A, Murphy E, Nagami E, Natarajan A, Nsahlai M, Nze C, Okwara N, Olds P, Paez R, Pardo M, Patel S, Petersen A, Phelan L, Pimenta E, Pipilas D, Plovanich M, Pong D, Powers BW, Rao A, Ramirez Batlle H, Ramsis M, Reichardt A, Reiger S, Rengarajan M, Rico S, Rome BN, Rosales R, Rotenstein L, Roy A, Royston S, Rozansky H, Rudder M, Ryan CE, Salgado S, Sanchez P, Schulte J, Sekar A, Semenkovich N, Shannon E, Shaw N, Shorten AB, Shrauner W, Sinnenberg L, Smithy JW, Snyder G, Sreekrishnan A, Stabenau H, Stavrou E, Stergachis A, Stern R, Stone A, Tabrizi S, Tanyos S, Thomas C, Thun H, Torres-Lockhart K, Tran A, Treasure C, Tsai FD, Tsaur S, Tschirhart E, Tuwatananurak J, Venkateswaran RV, Vishnevetsky A, Wahl L, Wall A, Wallace F, Walsh E, Wang P, Ward HB, Warner LN, Weeks LD, Weiskopf K, Wengrod J, Williams JN, Winkler M, Wong JL, Worster D, Wright A, Wunsch C, Wynter JS, Yarbrough C, Yau WY, Yazdi D, Yeh J, Yialamas MA, Yozamp N, Zambrotta M, Zon R. Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center. Circ Heart Fail 2019; 12:e006214. [PMID: 31658831 DOI: 10.1161/circheartfailure.119.006214] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. RESULTS Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84-0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72-0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. CONCLUSIONS Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.
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Affiliation(s)
- Lauren A Eberly
- University of Pennsylvania, Department of Medicine, Division of Cardiovascular Medicine, Philadelphia, PA (L.A.E.)
| | - Aaron Richterman
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Anne G Beckett
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Bram Wispelwey
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Regan H Marsh
- Department of Emergency Medicine (R.H.M., E.C.C.M., C.Y.C), Brigham and Women's Hospital, Boston, MA
| | | | - Cindy Y Chang
- Department of Emergency Medicine (R.H.M., E.C.C.M., C.Y.C), Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA (C.Y.C)
| | - Robert J Glynn
- Division of Preventive Medicine, Department of Medicine (R.J.G.), Brigham and Women's Hospital, Boston, MA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (R.J.G)
| | - Katherine C Brooks
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Robert Boxer
- Division of General Internal Medicine, Department of Medicine (R.B.), Brigham and Women's Hospital, Boston, MA
| | - Rose Kakoza
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Jennifer Goldsmith
- Division of Global Health Equity, Department of Medicine (J.G., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Joseph Loscalzo
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Michelle Morse
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA.,Division of Global Health Equity, Department of Medicine (J.G., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Eldrin F Lewis
- Division of Cardiovascular Medicine, and Department of Medicine (E.F..L.), Brigham and Women's Hospital, Boston, MA
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Abstract
Chitin is a β-linked straight chain carbohydrate matrix monopolymer prominent in invertebrates, from fungi to arthropods. Surprisingly, chitin is now documented in vertebrates, including humans, a component of vertebrate physiology that has been neglected until now. Chitin levels are elevated in Alzheimer's disease (AD) patients, not only in the central nervous system but also in the cerebrospinal fluid and plasma. Elevated levels of chitin lectin have been reported in patients with AD. Chitinase activity varies widely in the human population. Chitin levels can increase in individuals with intrinsically low chitinase activity. Elevated amounts of chitin can reflect accumulation of the small chitin fragments that remain wherever rapid hyaluronan synthesis occurs. Another source of chitin may be from remote fungal infections. Chitin can be toxic for neurons, and its accumulation may lead to the development of AD. We present new suggestions for animal models and treatment modalities that could prove useful in future research endeavors. An unexpected connection with Gaucher's disease patients and their heterozygote relatives is also identified. These chitin-related mechanisms are novel approaches to AD whose etiology until now has defied explication.
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Affiliation(s)
- Christine Lomiguen
- Department of Anatomy, Touro College of Osteopathic Medicine, New York, NY, USA
| | - Luis Vidal
- Department of Anatomy, Touro College of Osteopathic Medicine, New York, NY, USA
| | - Piotr Kozlowski
- Professor of Pathology and Dean for Research, Touro College of Osteopathic Medicine, New York, NY, USA
| | - Arthur Prancan
- Associate Professor of Pharmacology and Pre-Clinical Dean, Touro College of Osteopathic Medicine, New York, NY, USA
| | - Robert Stern
- Department of Basic Biomedical Sciences, Touro College of Osteopathic Medicine, New York, NY, USA
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Garcia-Doval I, Descalzo M, Mason K, Cohen A, Ormerod A, Gómez-García F, Cazzaniga S, Feldhamer I, Ali H, Herrera-Acosta E, Griffiths C, Stern R, Naldi L. Biological therapy for psoriasis and risk of cancer. Br J Dermatol 2018. [DOI: 10.1111/bjd.17166] [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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Garcia-Doval I, Descalzo M, Mason K, Cohen A, Ormerod A, Gómez-García F, Cazzaniga S, Feldhamer I, Ali H, Herrera-Acosta E, Griffiths C, Stern R, Naldi L. 银屑病的生物治疗和癌症风险. Br J Dermatol 2018. [DOI: 10.1111/bjd.17177] [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: 12/01/2022]
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15
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Fede C, Angelini A, Stern R, Macchi V, Porzionato A, Ruggieri P, De Caro R, Stecco C. Quantification of hyaluronan in human fasciae: variations with function and anatomical site. J Anat 2018; 233:552-556. [PMID: 30040133 DOI: 10.1111/joa.12866] [Citation(s) in RCA: 24] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
Recently, alterations in fascial gliding-like movement have been invoked as critical in the etiology of myofascial pain. Various methods have been attempted for the relief of this major and debilitating clinical problem. Paramount have been attempts to restore correct gliding between fascial layers and the movement over bone, joint, and muscular structures. One of the key elements that underlies such fascial movement is hyaluronan. However, until now, the precise content of hyaluronan within fasciae has been unknown. This study quantifies for the first time the hyaluronan content of human fascial samples obtained from a variety of anatomic sites. Here, we demonstrate that the average amount varies according to anatomic site, and according to the different kinds of sliding properties of the particular fascia. For example, the fascia lata has 35 μg of hyaluronan per gram of tissue, similar to that of the rectus sheath (29 μg g-1 ). However, the types of fascia adherent to muscle contain far less hyaluronan: 6 μg g-1 in the fascia overlying the trapezius and deltoid muscles. In the fascia that surrounds joints, the hyaluronan increases to 90 μg g-1 , such as in the retinacula of the ankle, where greater degrees of movement occur. Surprisingly, no significant differences were detected at any site as a function of age or sex (P-value > 0.05, t-test) with the sole exception of the plantar fascia. This work can provide a better understanding of the role of hyaluronan in fascia. It will facilitate a better comprehension of the modulation of the hyaluronan-rich layer that occurs in relation to the various conditions that affect fascia, and the diverse factors that underlie the attendant pathologies.
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Affiliation(s)
- C Fede
- Department of Neuroscience, University of Padua, Padua, Italy
| | - A Angelini
- Department of Surgery, Oncology and Gastroenterology DiSCOG, Orthopedic Clinic, University of Padua, Padua, Italy
| | - R Stern
- Division of Basic Biomedical Sciences, Touro College of Osteopathic Medicine, New York, NY, USA
| | - V Macchi
- Department of Neuroscience, University of Padua, Padua, Italy
| | - A Porzionato
- Department of Neuroscience, University of Padua, Padua, Italy
| | - P Ruggieri
- Department of Surgery, Oncology and Gastroenterology DiSCOG, Orthopedic Clinic, University of Padua, Padua, Italy
| | - R De Caro
- Department of Neuroscience, University of Padua, Padua, Italy
| | - C Stecco
- Department of Neuroscience, University of Padua, Padua, Italy
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Gordon KB, Koo JYM, Feldman SR, Menter A, Krueger G, Krueger G, Bagel J, Blauvelt A, Day RM, Elder J, Feldman SR, Gottlieb A, Koo JYM, Lebwohl M, Menter A, Paller A, Pariser D, Stern R, Weinstein G. Definitions of Measures of Effect Duration for Psoriasis Treatments. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/247553030208a00301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Abstract
SummaryThe turnover of labeled bovine thrombin was studied in heparinized dogs. The results of these studies indicate that1. thrombin is rapidly removed from the blood, clearance takes place predominantly by the liver ;2. the uptake occurs by the Kupffer cells ;3. after its uptake the thrombin is rapidly broken down ;4. in the absence of the liver thrombin is slowly cleared by extrahepatic phagocytes ;5. the rate of thrombin clearance is so rapid and its critical dose so small that this protein can be used to study hepatic blood flow and Kupffer cell clearance function.
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Stecco C, Fede C, Macchi V, Porzionato A, Petrelli L, Biz C, Stern R, De Caro R. The fasciacytes: A new cell devoted to fascial gliding regulation. Clin Anat 2018; 31:667-676. [DOI: 10.1002/ca.23072] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Carla Stecco
- Department of Neuroscience; University of Padova, via Gabelli 65; Padova 35121 Italy
| | - Caterina Fede
- Department of Neuroscience; University of Padova, via Gabelli 65; Padova 35121 Italy
| | - Veronica Macchi
- Department of Neuroscience; University of Padova, via Gabelli 65; Padova 35121 Italy
| | - Andrea Porzionato
- Department of Neuroscience; University of Padova, via Gabelli 65; Padova 35121 Italy
| | - Lucia Petrelli
- Department of Neuroscience; University of Padova, via Gabelli 65; Padova 35121 Italy
| | - Carlo Biz
- Department of Surgery, Oncology and Gastroenterology DiSCOG; Orthopedic Clinic, University of Padova, via Giustiniani 2; Padova 35121 Italy
| | - Robert Stern
- Division of Basic Biomedical Sciences; Touro College of Osteopathic Medicine, 230 West-125th Street; New York New York 10027
| | - Raffaele De Caro
- Department of Neuroscience; University of Padova, via Gabelli 65; Padova 35121 Italy
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Danielson B, Chen CH, Kaber G, Mochly-Rosen D, Grimes K, Stern R, Bollyky PL. Human Chitotriosidase Does Not Catabolize Hyaluronan. Int J Biol Macromol 2017; 109:629-633. [PMID: 29247734 DOI: 10.1016/j.ijbiomac.2017.11.181] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/07/2017] [Accepted: 11/28/2017] [Indexed: 12/25/2022]
Abstract
Humans express an enzyme that degrades chitin, called chitotriosidase, despite the fact that we do not produce chitin. One possible explanation for this is that chitinase also degrades hyaluronan, a polysaccharide that is abundant in human tissues and shares structural attributes in common with chitinase. The objective of this study was to determine whether human chitotriosidase is capable of hydrolyzing hyaluronan. Hyaluronan of various sizes under a range of pH conditions displayed no degradation when incubated with various chitinases over a period of 5 days, while commercial hyaluronidase readily digested the hyaluronan. Under the same conditions, recombinant chitinase but not our negative control chitinase, was able to digest chitosan. We conclude that human chitinase does not digest hyaluronan. Because chitin is a prominent component of certain fungi and insects, it seems likely that human chitinase evolved for roles in host defense rather than serving to catabolize the endogenous polymer hyaluronan.
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Affiliation(s)
- Ben Danielson
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Che-Hong Chen
- Department of Chemical and Systems Biology Operations, Stanford University School of Medicine, Stanford, CA, USA
| | - Gernot Kaber
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology Operations, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin Grimes
- Department of Chemical and Systems Biology Operations, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert Stern
- Department of Basic Biomedical Sciences, Touro-Harlem College of Osteopathic Medicine, New York, NY, USA
| | - Paul L Bollyky
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Sugarman M, Alosco M, Steinberg E, Tripodis Y, Stern R. A-22Neuropsychiatric Symptoms and the Diagnostic Stability of Mild Cognitive Impairment. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.22] [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: 11/14/2022] Open
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21
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Davids MS, Huang Y, Rogers KA, Stern R, Brown JR, Thompson PA, Brander DM, Danilov AV, Ujjani CS, Parikh SA, Barrientos JC, Tam C, Woyach JA. Richter's syndrome (RS) in patients with chronic lymphocytic leukemia (CLL) on novel agent therapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7505] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7505 Background: Novel agents (NA) targeting B cell receptor kinases and Bcl-2 have substantially improved outcomes in CLL; however, the development of RS in CLL patients (pts) on NAs has been observed, and has not been systematically evaluated. Methods: We retrospectively reviewed pts at 9 academic centers diagnosed with pathologically-confirmed RS from 2011-16. Informed consent was provided through IRB-approved protocols. Descriptive statistics were utilized and overall survival (OS) was calculated from RS diagnosis (dx) to death or last follow-up by Kaplan-Meier. Results: 71 pts who developed RS on NAs for CLL were identified. Median age at CLL dx was 55 yrs (range 21-82), median of 3 therapies (range 0-12) prior to the NA. 68% pts were fludarabine-refractory, and 5 pts (7%) had relapsed post alloHCT. Median time from CLL dx to initiation of NA was 68.5 mo. (range 1.1-246.2). FISH at NA initiation: del(17p) 30/61 (49%), del(11q) 15/61 (25%), trisomy 12 15/61 (25%). Complex karyotype was present in 40/53 (75%). 46/52 (88%) were IGHV unmutated, VH1-69 10/43 (23%), VH4-39 4/43 (9%). 59 (83%) pts were on a BTK inhibitor, 6 (8%) PI3K inhibitor, 6 (8%) venetoclax. RS histology: DLBCL (87%), plasmablastic (6%), Hodgkin (4%), 3% other. RS Ki-67%: >90 (23%), 75-90 (25%), 50-75% (25%), <50% (28%). Median time from start of NA to RS dx was 9.1 mo (range 0.9-48.2), with 65% developing RS within 12 mo. of starting NA. In 56 pts, 19 different regimens were used as initial RS therapy, including: R-EPOCH (36%), R-CHOP (20%), checkpoint blockade (9%), OFAR (7%), or a different NA (7%). Of the 48 pts evaluable for response, ORR was 42% (15% CR, 27% PR). In 29 evaluable pts receiving R-EPOCH/CHOP, ORR was 48% (21% CR). With a median follow-up of 10.6 mo., median OS was only 3.3 mo. (95%CI 2.2-6.0), though none of the 7 pts who achieved CR has died. Conclusions: We report to our knowledge the largest series of CLL pts developing RS on NAs. Pts often had high risk CLL, particularly complex cytogenetics, and RS frequently developed within the first year of NA therapy. Substantial variation exists in treatment, and outcomes are poor for those who do not achieve CR. Identification of molecular drivers of RS and development of novel treatment strategies are urgently needed.
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Affiliation(s)
| | | | | | | | | | - Philip A. Thompson
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | - Jennifer Ann Woyach
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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22
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Gérard R, Kerfant N, Dubois de Mont Marin G, Stern R, Assal M. Hawkins' type-II talar fracture with subtalar dislocation: A very unusual combination. Orthop Traumatol Surg Res 2017; 103:403-406. [PMID: 28087394 DOI: 10.1016/j.otsr.2016.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/13/2016] [Accepted: 12/27/2016] [Indexed: 02/02/2023]
Abstract
We report the unusual case of a 16-year-old young man who sustained a rare association of a Hawkins' type-II talar neck fracture with a complete medial subtalar dislocation (Hawkins type-IIB) that occurred as an isolated injury after indirect trauma during a soccer game. Following closed reduction of the subtalar dislocation, standard radiographs and computed tomography (CT) demonstrated a comminuted fracture of the talus involving the base of the talar neck. Open reduction was performed and the fracture was stabilized by ORIF. At 1-year follow-up, functional and radiographic outcomes were graded as excellent, with no radiographic evidence of talar osteonecrosis.
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Affiliation(s)
- R Gérard
- Department of orthopaedic and trauma surgery, Polyclinique Keraudren, rue Ernestine-de-Trémaudan, 29200 Brest, France.
| | - N Kerfant
- Department of trauma and reconstructive surgery, Brest University Hospital Center, La Cavale Blanche, boulevard Tanguy-Prigent, 29200 Brest, France
| | - G Dubois de Mont Marin
- Department of orthopaedic and trauma surgery, Polyclinique Keraudren, rue Ernestine-de-Trémaudan, 29200 Brest, France
| | - R Stern
- Foot and Ankle Center, Clinique La Colline, avenue de Beau-Séjour 6, 1206 Geneva, Switzerland
| | - M Assal
- Foot and Ankle Center, Clinique La Colline, avenue de Beau-Séjour 6, 1206 Geneva, Switzerland
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Kutaish H, Stern R, Drittenbass L, Assal M. Injuries to the Chopart joint complex: a current review. Eur J Orthop Surg Traumatol 2017; 27:425-431. [DOI: 10.1007/s00590-017-1958-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
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Abstract
Hyaluronan is the major extracellular matrix glycosaminoglycan polymer present in vertebrate tissues, with a molar mass that can reach several megaDaltons. It is particularly prominent in the matrix of tissues undergoing rapid turnover, in fetal tissues, and wherever regeneration and repair are occurring. Hyaluronan has highly varied biological functions often dependent on molar mass, however they are highly dependent on source of hyaluronan, its purity and nature of contaminants. Hyaluronan of highmolar- mass is known for its anti-angiogenic, anti-inflammatory and immunosuppressive properties, unlike hyaluronan of low-molar-mass that has the opposite effects. Hyaluronan also has a broad range of clinical applications, such as intra-articular injection, in ophthalmology, otolaryngology, wound healing, and commercially in the cosmetic industry, as well as in drug delivery systems. Currently, polymers of hyaluronan are modified in order to improve their properties, including bioavailability and resistance to degradation. Because of greatly increased interest currently in hyaluronan, the multiple functions of the polymer are presented here, including medicine and industry, as well as recent progress in the formulation of hyaluronan-based materials.
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Affiliation(s)
| | - Nicola Volpi
- Department of Life Sciences, University of Modena & Reggio Emilia, Via Campi 213/D, 41100 Modena, Italy..
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25
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Rivers DA, Stern R, Maibach HI. A defective inflammatory response may underlie cases of atopic dermatitis. J Eur Acad Dermatol Venereol 2017; 31:e313-e315. [PMID: 28000285 DOI: 10.1111/jdv.14099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D A Rivers
- Department of Biomedical Sciences, Touro College of Osteopathic Medicine, New York, NY, USA
| | - R Stern
- Department of Biomedical Sciences, Touro College of Osteopathic Medicine, New York, NY, USA
| | - H I Maibach
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
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Abstract
A controversy arose decades ago whether the DG42 gene product expressed during frog embryogenesis synthesized hyaluronan or chitin. Both sets of investigators were correct. It is now possible to understand how prescient those findings were. Synthesis of a seven to nine chitin sugar chain fragment is required before hyaluronan synthesis begins. Thus, DG42 indeed synthesizes both hyaluronan and chitin. Hyaluronan turns over rapidly in vertebrate tissues, but chitin oligomers are difficult to degrade. They accumulate and can cause pathology. Chitin is a simple beta-linked repeating sugar homopolymer found prominently in the building block structures of fungi, molluscs, arthropods, and other forms of invertebrate life. It is a highly resistant insoluble material requiring chitin synthases for production and chitinases for degradation. Mysteriously, chitins and chitinases also occur in vertebrate tissues, while it had previously been assumed that no chitins were contained therein. That assumption is now challenged based on recent biochemical evidence. Chitin does accumulate in many tissues, but may be particularly toxic to neurons. Its accumulation in the brain may account for the cognitive decline found in patients with Alzheimer's disease. The DG42 observations together with the participation of chitins and chitinases in several human diseases, among which in addition to Alzheimer's disease include Gaucher's disease, asthma, and aspects of abnormal immune recognition justify a reexamination of these topics. The purpose of this review is to summarize data in order to place chitins and their attendant enzymes in a rational framework in an attempt to create a cohesive story.
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Affiliation(s)
- Robert Stern
- Department of Basic Biomedical Sciences, Touro-Harlem College of Osteopathic Medicine, 230 West-125th Street, New York, NY 10027, USA,
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Kohlrautz J, Haase J, Green EL, Zhang ZT, Wosnitza J, Herrmannsdörfer T, Dabkowska HA, Gaulin BD, Stern R, Kühne H. Field-stepped broadband NMR in pulsed magnets and application to SrCu2(BO3)2 at 54T. J Magn Reson 2016; 271:52-59. [PMID: 27552555 DOI: 10.1016/j.jmr.2016.08.005] [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] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
Pulsed magnets generate the highest magnetic fields as brief transients during which the observation of NMR is difficult, however, this is the only route to unique insight into material properties up to the regime of 100T. Here, it is shown how rather broad NMR spectra can be assembled in a pulsed magnet during a single field pulse by using the inherent time dependence of the field for the recording of field-stepped free induction decays that cover a broad frequency range. The technique is then applied to (11)B NMR of the spin-dimer system SrCu2(BO3)2, a magnetic insulator known to undergo a series of field-driven changes of the magnetic ground state. At peak fields of about 54T at the Dresden High Magnetic Field Laboratory, (11)B NMR spectra spanning a total of about 9MHz width are reconstructed. The results are in good accordance with a change from a high-temperature paramagnetic state to a low-temperature commensurate superstructure of field-induced spin-dimer triplets.
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Affiliation(s)
- J Kohlrautz
- University of Leipzig, Faculty of Physics and Earth Sciences, Linnéstraße 5, 04103 Leipzig, Germany.
| | - J Haase
- University of Leipzig, Faculty of Physics and Earth Sciences, Linnéstraße 5, 04103 Leipzig, Germany
| | - E L Green
- Dresden High Magnetic Field Laboratory (HLD-EMFL), Helmholtz-Zentrum Dresden-Rossendorf, 01314 Dresden, Germany
| | - Z T Zhang
- Dresden High Magnetic Field Laboratory (HLD-EMFL), Helmholtz-Zentrum Dresden-Rossendorf, 01314 Dresden, Germany
| | - J Wosnitza
- Dresden High Magnetic Field Laboratory (HLD-EMFL), Helmholtz-Zentrum Dresden-Rossendorf, 01314 Dresden, Germany; Institut für Festkörperphysik, TU Dresden, 01062 Dresden, Germany
| | - T Herrmannsdörfer
- Dresden High Magnetic Field Laboratory (HLD-EMFL), Helmholtz-Zentrum Dresden-Rossendorf, 01314 Dresden, Germany
| | - H A Dabkowska
- Brockhouse Institute for Materials Research and Department of Physics and Astronomy, McMaster University, 1280 Main Str West, ON L8S 4M1, Canada
| | - B D Gaulin
- Brockhouse Institute for Materials Research and Department of Physics and Astronomy, McMaster University, 1280 Main Str West, ON L8S 4M1, Canada
| | - R Stern
- National Institute of Chemical Physics and Biophysics (NICPB), Akadeemia Tee 23, 12618 Tallinn, Estonia
| | - H Kühne
- Dresden High Magnetic Field Laboratory (HLD-EMFL), Helmholtz-Zentrum Dresden-Rossendorf, 01314 Dresden, Germany
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Hoffman D, Dyer B, Kumaran Nair C, Stern R, Benedict S, Davis UC. SU-F-T-471: Simulated External Beam Delivery Errors Detection with a Large Area Ion Chamber Transmission Detector. Med Phys 2016. [DOI: 10.1118/1.4956656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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29
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Stecco A, Stern R, Fantoni I, De Caro R, Stecco C. Fascial Disorders: Implications for Treatment. PM R 2016; 8:161-8. [DOI: 10.1016/j.pmrj.2015.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 06/03/2015] [Accepted: 06/07/2015] [Indexed: 01/26/2023]
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Pavan P, Stecco A, Stern R, logna Prat P, Stecco C. Fibrosis and densification: Anatomical vs functional alteration of the fascia. J Bodyw Mov Ther 2016. [DOI: 10.1016/j.jbmt.2015.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Aya KL, Stern R. Hyaluronan in wound healing: rediscovering a major player. Wound Repair Regen 2015; 22:579-93. [PMID: 25039417 DOI: 10.1111/wrr.12214] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 07/11/2014] [Indexed: 12/12/2022]
Abstract
Wound healing involves a series of carefully modulated steps, from initial injury and blood clot to the final reconstituted tissue or scar. A dynamic reciprocity exists throughout between the wound, blood elements, extracellular matrix, and cells that participate in healing. Multiple cytokines and signal transduction pathways regulate these reactions. A major component throughout most of the process is hyaluronan, a straight-chain carbohydrate extracellular matrix polymer. Hyaluronan occurs in multiple forms, chain length being the only distinguishing characteristic between them. Levels of hyaluronan in its high-molecular-weight form are prominent in the earliest stages of wound repair. Progressively more fragmented forms occur in a manner not previously appreciated. We outline here steps in the wound healing cascade in which hyaluronan participates, as well as providing a review of its metabolism. Although described by necessity in a series of quantum steps, the healing process is constituted by a smooth continuum of overlapping reactions. The prevalence of hyaluronan in the wound (initially termed "hexosamine-containing mucopolysaccharide"), particularly in its early stages, was pointed out over half a century ago by the Harvard surgeon J. Engelbert Dunphy. It appears we are now returning to where we started.
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Affiliation(s)
- Kessiena L Aya
- Department of Basic Biomedical Sciences, Touro College of Osteopathic Medicine, New York, New York
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Hoffman D, Chung E, Hess C, Stern R, Benedict S. SU-E-T-571: Newly Emerging Integrated Transmission Detector Systems Provide Online Quality Assurance of External Beam Radiation Therapy. Med Phys 2015. [DOI: 10.1118/1.4924933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Robrade K, Stern R, Almanzar G, Kleines M, Speth F, Hügle B, Haas J, Prelog M. AB0030 Persistence of Humoral and Cellular Immunity Against Tick-Borne-Encephalitis Vaccination in Patients with Juvenile Idiopathic Arthritis (JIA). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5567] [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: 11/03/2022]
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Holzer N, Salvo D, Marijnissen ACA, Vincken KL, Ahmad AC, Serra E, Hoffmeyer P, Stern R, Lübbeke A, Assal M. Radiographic evaluation of posttraumatic osteoarthritis of the ankle: the Kellgren-Lawrence scale is reliable and correlates with clinical symptoms. Osteoarthritis Cartilage 2015; 23:363-9. [PMID: 25463444 DOI: 10.1016/j.joca.2014.11.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 10/27/2014] [Accepted: 11/07/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess reliability and construct validity of the Kellgren-Lawrence (K&L) scale in posttraumatic ankle osteoarthritis (OA); additionally evaluate the validity of including tibiotalar tilting in the scale. METHOD One-hundred and fifty ankle radiographs (75 patients, unilateral malleolar fractures) evaluated at average of 18 years after surgery. American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot (HF) score and pain (visual analog scale) were recorded. Grading of OA according to K&L criteria and identification of OA features was performed on standardized radiographs by four physicians. Minimal joint space width, sclerosis, and talar tilt angle were quantified by digital measurements. A modified K&L scale including talar tilting is presented. Validity of original and modified scale was evaluated and expressed as ability to (1) Identify those with clinical symptoms of ankle OA; and (2) Distinguish between different degrees of fracture severity. RESULTS Inter- and intra-observer reliability of OA assessment according to K&L were good (ICC 0.61 and 0.75). Original and modified K&L grades significantly increased with decreasing AOFAS ankle-HF scores and greater pain. A talar-tilt angle > 2° compared with ≤ 2° in grade 3 was associated with significantly higher pain levels (VAS pain 4.2 vs 1.4, respectively; mean difference 2.8, 95% CI 0.5-5.1). More severe fracture patterns at time of surgery were more often in patients with the highest K&L grades. CONCLUSIONS The K&L scale is a valid and reliable radiographic grading system for assessment of ankle OA. Inclusion of the talar tilt angle might allow for better differentiation with respect to clinical outcomes.
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Affiliation(s)
- N Holzer
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland.
| | - D Salvo
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - A C A Marijnissen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands
| | - K L Vincken
- Imaging Sciences Institute, University Medical Center Utrecht, The Netherlands
| | - A C Ahmad
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - E Serra
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - P Hoffmeyer
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - R Stern
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - A Lübbeke
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
| | - M Assal
- Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Switzerland
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Abstract
Goodpasture's syndrome is a rare disease that involves rapidly progressive kidney failure as well as hemorrhagic lung disease. It is a form of autoimmune disorder with unusual features; marked male preponderance, in contrast with other autoimmune disease in which females are at far greater risk. The autoantibodies are directed again the carboxy-extension non-collagenous (NC1) portion of one of the basement membrane-specific collagen IV alpha 3 chains. Basal laminas throughout the body share this structure, including those in kidney, lung and skin. But curiously, skin is rarely involved in Goodpasture's syndrome. Hyaluronan is a large extracellular matrix carbohydrate polymer. Half of total body hyaluronan occurs in skin. High molecular weight hyaluronan, a potent immunosuppressive polymer, might be functioning as an immune shield for skin in Goodpasture's syndrome, and be the basis for the anomaly. A summary of this putative effect is described, including possible molecular mechanisms involved, and suggestions for testing this hypothesis.
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Affiliation(s)
- A Stern
- Division of Nephrology, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, 79-01 Broadway, Elmhurst, NY 11373, United States.
| | - R Stern
- Department of Basic Biomedical Sciences, Touro/Harlem College of Osteopathic Medicine, 230 West-125th Street, New York, NY 10027, United States
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Abstract
This paper introduces a novel encoding of Model Based Diagnosis (MBD) to Boolean Satisfaction (SAT) focusing on minimal cardinality diagnosis. The encoding is based on a combination of sophisticated MBD preprocessing algorithms and the application of a SAT compiler which optimizes the encoding to provide more succinct CNF representations than obtained with previous works. Experimental evidence indicates that our approach is superior to all published algorithms for minimal cardinality MBD. In particular, we can determine, for the first time, minimal cardinality diagnoses for the entire standard ISCAS-85 and 74XXX benchmarks. Our results open the way to improve the state-of-the-art on a range of similar MBD problems.
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Lübbeke A, Gonzalez A, Garavaglia G, Roussos C, Bonvin A, Stern R, Peter R, Hoffmeyer P. A comparative assessment of small-head metal-on-metal and ceramic-on-polyethylene total hip replacement. Bone Joint J 2014; 96-B:868-75. [PMID: 24986938 DOI: 10.1302/0301-620x.96b7.32369] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Large-head metal-on-metal (MoM) total hip replacements (THR) have given rise to concern. Comparative studies of small-head MoM THRs over a longer follow-up period are lacking. Our objective was to compare the incidence of complications such as infection, dislocation, revision, adverse local tissue reactions, mortality and radiological and clinical outcomes in small-head (28 mm) MoM and ceramic-on-polyethylene (CoP) THRs up to 12 years post-operatively. A prospective cohort study included 3341 THRs in 2714 patients. The mean age was 69.1 years (range 24 to 98) and 1848 (55.3%) were performed in women, with a mean follow-up of 115 months (18 to 201). There were 883 MoM and 2458 CoP bearings. Crude incidence rates (cases/1000 person-years) were: infection 1.3 vs 0.8; dislocation 3.3 vs 3.1 and all-cause revision 4.3 vs 2.2, respectively. There was a significantly higher revision rate after ten years (adjusted hazard ratio 9.4; 95% CI 2.6 to 33.6) in the MoM group, and ten of 26 patients presented with an adverse local tissue reaction at revision. No differences in mortality, osteolysis or clinical outcome were seen. In conclusion, we found similar results for small-head MoM and CoP bearings up to ten years post-operatively, but after ten years MoM THRs had a higher risk of all-cause revision. Furthermore, the presence of an adverse response to metal debris seen in the small-head MOM group at revision is a cause for concern.
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Affiliation(s)
- A Lübbeke
- Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
| | - A Gonzalez
- Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
| | - G Garavaglia
- Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
| | - C Roussos
- Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
| | - A Bonvin
- Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
| | - R Stern
- Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
| | - R Peter
- Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
| | - P Hoffmeyer
- Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
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38
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Stern R. At a Crossroads? Reflections on the Right to Asylum for European Union Citizens. Refugee Survey Quarterly 2014. [DOI: 10.1093/rsq/hdu003] [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: 11/14/2022]
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Abstract
When solving instances of problem domains that feature a large branching factor, A* may generate a large number of nodes whose cost is greater than the cost of the optimal solution. We designate such nodes as surplus. Generating surplus nodes and adding them to the OPEN list may dominate both time and memory of the search. A recently introduced variant of A* called Partial Expansion A* (PEA*) deals with the memory aspect of this problem. When expanding a node n, PEA* generates all of its children and puts into OPEN only the children with f = f (n). n is re-inserted in the OPEN list with the f -cost of the best discarded child. This guarantees that surplus nodes are not inserted into OPEN.
In this paper, we present a novel variant of A* called Enhanced Partial Expansion A* (EPEA*) that advances the idea of PEA* to address the time aspect. Given a priori domain- and heuristic- specific knowledge, EPEA* generates only the nodes with f = f(n). Although EPEA* is not always applicable or practical, we study several variants of EPEA*, which make it applicable to a large number of domains and heuristics. In particular, the ideas of EPEA* are applicable to IDA* and to the domains where pattern databases are traditionally used. Experimental studies show significant improvements in run-time and memory performance for several standard benchmark applications. We provide several theoretical studies to facilitate an understanding of the new algorithm.
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Qiu WQ, Mwamburi M, Besser LM, Zhu H, Li H, Wallack M, Phillips L, Qiao L, Budson AE, Stern R, Kowall N. Angiotensin converting enzyme inhibitors and the reduced risk of Alzheimer's disease in the absence of apolipoprotein E4 allele. J Alzheimers Dis 2014; 37:421-8. [PMID: 23948883 PMCID: PMC3972060 DOI: 10.3233/jad-130716] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Our cross-sectional study showed that the interaction between apolipoprotein E4 (ApoE4) and angiotensin converting enzyme (ACE) inhibitors was associated with Alzheimer’s disease (AD). The aim of this longitudinal study was to differentiate whether ACE inhibitors accelerate or reduce the risk of AD in the context of ApoE alleles. Using the longitudinal data from the National Alzheimer’s Coordinating Center (NACC) with ApoE genotyping and documentation of ACE inhibitors use, we found that in the absence of ApoE4, subjects who had been taking central ACE inhibitor use (χ2 test: 21% versus 27%, p = 0.0002) or peripheral ACE inhibitor use (χ2 test: 13% versus 27%, p < 0.0001) had lower incidence of AD compared with those who had not been taking an ACE inhibitor. In contrast, in the presence of ApoE4, there was no such association between ACE inhibitor use and the risk of AD. After adjusting for the confounders, central ACE inhibitor use (OR = 0.68, 95% CI = 0.55, 0.83, p = 0.0002) or peripheral ACE inhibitor use (OR = 0.33, 95% CI = 0.33, 0.68, p < 0.0001) still remained inversely associated with a risk of developing AD in ApoE4 non-carriers. In conclusion, ACE inhibitors, especially peripherally acting ones, were associated with a reduced risk of AD in the absence of ApoE4, but had no such effect in those carrying the ApoE4 allele. A double-blind clinical trial should be considered to determine the effect of ACE inhibitors on prevention of AD in the context of ApoE genotype.
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Affiliation(s)
- Wei Qiao Qiu
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA Department of Psychiatry, and Boston University School of Medicine, Boston, MA, USA Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, USA
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Bouvet C, Lübbeke A, Bandi C, Pagani L, Stern R, Hoffmeyer P, Uçkay I. Is there any benefit in pre-operative urinary analysis before elective total joint replacement? Bone Joint J 2014; 96-B:390-4. [DOI: 10.1302/0301-620x.96b3.32620] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Whether patients with asymptomatic bacteriuria should be investigated and treated before elective hip and knee replacement is controversial, although it is a widespread practice. We conducted a prospective observational cohort study with urine analyses before surgery and three days post-operatively. Patients with symptomatic urinary infections or an indwelling catheter were excluded. Post-discharge surveillance included questionnaires to patients and general practitioners at three months. Among 510 patients (309 women and 201 men), with a median age of 69 years (16 to 97) undergoing lower limb joint replacements (290 hips and 220 knees), 182 (36%) had pre-operative asymptomatic bacteriuria, mostly due to Escherichia coli, and 181 (35%) had white cells in the urine. Most patients (95%) received a single intravenous peri-operative dose (1.5 g) of cefuroxime as prophylaxis. On the third post-operative day urinary analysis identified white cells in 99 samples (19%) and bacteriuria in 208 (41%). Pathogens in the cultures on the third post-operative day were different from those in the pre-operative samples in 260 patients (51%). Only 25 patients (5%) developed a symptomatic urinary infection during their stay or in a subsequent three-month follow-up period, and two thirds of organisms identified were unrelated to those found during the admission. All symptomatic infections were successfully treated with oral antibiotics with no perceived effect on the joint replacement. We conclude that testing and treating asymptomatic urinary tract colonisation before joint replacement is unnecessary. Cite this article: Bone Joint J 2014;96-B:390–4.
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Affiliation(s)
- C. Bouvet
- Geneva University Hospitals, Orthopaedic
Surgery Service, 1211 Geneva 14, Switzerland
| | - A. Lübbeke
- Geneva University Hospitals, Orthopaedic
Surgery Service, 1211 Geneva 14, Switzerland
| | - C. Bandi
- Geneva University Hospitals, Orthopaedic
Surgery Service, 1211 Geneva 14, Switzerland
| | - L. Pagani
- Geneva University Hospitals, Service
of Infectious Diseases, 1211 Geneva 14, Switzerland
| | - R. Stern
- Geneva University Hospitals, Orthopaedic
Surgery Service, 1211 Geneva 14, Switzerland
| | - P. Hoffmeyer
- Geneva University Hospitals, Orthopaedic
Surgery Service, 1211 Geneva 14, Switzerland
| | - I. Uçkay
- Geneva University Hospitals, Orthopaedic
Surgery Service, 1211 Geneva 14, Switzerland
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Juranek I, Stern R, Soltes L. Hyaluronan peroxidation is required for normal synovial function: an hypothesis. Med Hypotheses 2014; 82:662-6. [PMID: 24655797 DOI: 10.1016/j.mehy.2014.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 02/14/2014] [Accepted: 02/23/2014] [Indexed: 12/11/2022]
Abstract
Despite widespread use of antioxidants, reactive oxygen species have important functions in normal tissues. Herein, we present an example of a physiological role for free radicals, and in particular, reactive oxygen species, that are suppressed by anti-oxidants. Free radicals catalyze the degradation of hyaluronan in synovial fluid, a tissue in which hyaluronidase activity is barely detectable. Articular cartilage requires a low oxygen environment. The process of hyaluronan peroxidation consumes significant amounts of molecular oxygen, thus keeping the tension of oxygen in the joint at a low but physiologically critical level. One concern is the change in physical activity between day and night, with periods of joint hyperemia and ischemia, respectively. Increased oxygen and the resulting oxidative stress would lead to chondrocyte dysfunction and cartilage damage. A mechanism for keeping oxygen levels low is required. We postulate that a mechanism indeed exists for the removal of excess oxygen. High-molar-mass hyaluronan turnover in synovial fluid utilizes peroxidative degradation, during which oxygen is massively consumed. The peroxidation itself may be initiated by hydrogen peroxide, which is produced by chondrocyte mitochondria, that can diffuse into the synovial fluid. The resulting decrease in available oxygen down-regulates hyaluronan peroxidation. This in turn prevents excessive oxygen consumption. It appears that free radicals and reactive oxygen species may be components of normal physiology, particularly in the synovial fluid of joints and articular cartilage. It is suggested therefore that indiscriminate use of anti-oxidants, vigorously promoted currently by health professionals and the health industry, be approached with caution.
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Affiliation(s)
- I Juranek
- Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, Dubravska Cesta 9, SK-84104 Bratislava, Slovakia
| | - R Stern
- Department of Basic Biomedical Sciences, Touro College of Osteopathic Medicine, 230 West-125th St., New York, NY 10027, USA.
| | - L Soltes
- Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, Dubravska Cesta 9, SK-84104 Bratislava, Slovakia
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Potočnik A, Ganin AY, Takabayashi Y, McDonald MT, Heinmaa I, Jeglič P, Stern R, Rosseinsky MJ, Prassides K, Arčon D. Jahn–Teller orbital glass state in the expanded fcc Cs3C60 fulleride. Chem Sci 2014. [DOI: 10.1039/c4sc00670d] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Magic-angle-spinning NMR measurements on fcc Cs3C60 to cryogenic temperatures reveal freezing-out of the C603¬ Jahn–Teller dynamics and emergence of an electronic orbital glass state guided by the C603¬ merohedral disorder.
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Affiliation(s)
- A. Potočnik
- Jožef Stefan Institute
- 1000 Ljubljana, Slovenia
| | - A. Y. Ganin
- Department of Chemistry
- University of Liverpool
- Liverpool L69 7ZD, UK
| | - Y. Takabayashi
- Department of Chemistry
- Durham University
- Durham DH1 3LE, UK
| | - M. T. McDonald
- Department of Chemistry
- Durham University
- Durham DH1 3LE, UK
| | - I. Heinmaa
- National Institute of Chemical Physics and Biophysics
- 12618 Tallinn, Estonia
| | - P. Jeglič
- Jožef Stefan Institute
- 1000 Ljubljana, Slovenia
- EN-FIST Centre of Excellence
- 1000 Ljubljana, Slovenia
| | - R. Stern
- National Institute of Chemical Physics and Biophysics
- 12618 Tallinn, Estonia
| | - M. J. Rosseinsky
- Department of Chemistry
- University of Liverpool
- Liverpool L69 7ZD, UK
| | - K. Prassides
- Department of Chemistry
- Durham University
- Durham DH1 3LE, UK
- WPI Research Center
- Advanced Institute for Materials Research
| | - D. Arčon
- Jožef Stefan Institute
- 1000 Ljubljana, Slovenia
- Faculty of Mathematics and Physics
- University of Ljubljana
- 1000 Ljubljana, Slovenia
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45
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Mayadev J, Dieterich S, Lentz S, Mathai M, Harse R, Courquin J, Stern R. Optimizing the process for maximum safety and efficiency in tandem and ring brachytherapy for cervical cancer using the failure modes and effect analysis. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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46
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Lee Y, Rash D, Stern R, Mathai M, Mayadev J. Positive pelvic lymph nodes in locally advanced cervical cancer: How much dose is given by the high dose rate brachytherapy? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.018] [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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47
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Mandelblatt J, Stern R, Luta G, Clapp J, Hurria A, Jacobsen P, Saykin A, Ahles T. Cognition in older breast cancer patients prior to systemictherapy: The Thinking and Living With Cancer (TLC) study. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.008] [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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48
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Valicenti R, Stern R, Purdy J, Mathai M, Harse R, Siefkin A. Effectiveness of Hospital-Based Incident Reporting and Learning System to Manage Radiation Treatment Errors. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Garcia-Doval I, Rustenbach S, Stern R, Dam T, Cohen A, Baker C, Spuls P, Naldi L. Systemic psoriasis therapy shows high between-country variation: a sign of unwarranted variation? Cross-sectional analysis of baseline data from the PSONET registries. Br J Dermatol 2013; 169:710-4. [DOI: 10.1111/bjd.12344] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- I. Garcia-Doval
- Department of Dermatology; Complexo Hospitalario de Pontevedra (CHOP); Pontevedra; Research Unit; Fundación Academia Española de Dermatología; Madrid; Spain
| | - S.J. Rustenbach
- German Center for Health Services Research in Dermatology; University Clinics of Hamburg; Hamburg; Germany
| | - R. Stern
- Department of Dermatology; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston; MA; U.S.A
| | - T.N. Dam
- Department of Dermatology; Roskilde Hospital; Roskilde; Denmark
| | - A.D. Cohen
- Department of Quality Measures and Research; Clalit Health Services; Tel Aviv and Siaal Research Center for Family Medicine and Primary Care; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva; Israel
| | - C. Baker
- Department of Dermatology; Skin and Cancer Foundation; St Vincent's Hospital Melbourne; University of Melbourne; Melbourne; VIC; Australia
| | - P.I. Spuls
- Department of Dermatology; Academic Medical Centre; University of Amsterdam; Amsterdam; the Netherlands
| | - L. Naldi
- Centro Studi GISED; Fondazione per la Ricerca; Ospedale Maggiore; Bergamo; Italy
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50
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Wallack M, Zhu H, Mwamburi M, Phillips L, Budson A, Kowall N, Stern R, Qiu WQ. P3–174: Apolipoprotein E allele and angiotensin‐converting enzyme and its inhibitors in the development of Alzheimer's disease. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Max Wallack
- Boston University Boston Massachusetts United States
| | - Haihao Zhu
- Boston University School of Medicine Boston Massachusetts United States
| | - Mkaya Mwamburi
- Tufts University School of Medicine Boston Massachusetts United States
| | - Leslie Phillips
- National Alzheimer's Coordinating Center Seattle Washington United States
| | - Andrew Budson
- Boston University Alzheimer's Disease Center Boston Massachusetts United States
| | - Neil Kowall
- Boston University Boston Massachusetts United States
| | - Robert Stern
- Boston University Boston Massachusetts United States
| | - Wei Qiao Qiu
- Boston University School of Medicine Boston Massachusetts United States
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