New York Methodist Hospital

About: New York Methodist Hospital is a healthcare organization based out in Brooklyn, New York, United States. It is known for research contribution in the topics: Myocardial infarction & Percutaneous coronary intervention. The organization has 948 authors who have published 936 publications receiving 29954 citations.

Model-guided therapy for hepatocellular carcinoma: a role for information technology in predictive, preventive and personalized medicine

Abstract: Predictive, preventive and personalized medicine (PPPM) may have the potential to eventually improve the nature of health care delivery. However, the tools required for a practical and comprehensive form of PPPM that is capable of handling the vast amounts of medical information that is currently available are currently lacking. This article reviews a rationale and method for combining and integrating diagnostic and therapeutic management with information technology (IT), in a manner that supports patients through their continuum of care. It is imperative that any program devised to explore and develop personalized health care delivery must be firmly rooted in clinically confirmed and accepted principles and technologies. Therefore, a use case, relating to hepatocellular carcinoma (HCC), was developed. The approach to the management of medical information we have taken is based on model theory and seeks to implement a form of model-guided therapy (MGT) that can be used as a decision support system in the treatment of patients with HCC. The IT structures to be utilized in MGT include a therapy imaging and model management system (TIMMS) and a digital patient model (DPM). The system that we propose will utilize patient modeling techniques to generate valid DPMs (which factor in age, physiologic condition, disease and co-morbidities, genetics, biomarkers and responses to previous treatments). We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient. An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists. The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

Holotranscobalamin: Not Ready for Prime Time

Abstract: To the Editor: In their recent article in Clinical Chemistry (1), Valente and colleagues advocate that holotranscobalamin II (holoTC)1 become the primary diagnostic test of vitamin B12 status. I believe that study flaws undercut the authors' recommendation. Moreover, the validation difficulties extend to deeper, more basic issues that continue to limit translation of the holoTC concept, despite its theoretical attractiveness. Validation efforts have typically compared holoTC against serum B12 in general populations and have used imperfect tools with often-arbitrary cutpoints to define B12 status. Such approaches and their reliance on methylmalonic acid (MMA), despite its questionable diagnostic specificity, have been critiqued (2). Valente et al. reuse this model with just 1 modification, the substitution of erythrocyte vitamin B12 (RBC-B12) for MMA as the arbiter of B12 status. That innovation misfires, however, because RBC-B12 is probably an even poorer standard than MMA. No convincing data anywhere, including the references cited by Valente and colleagues, justify the report's assumption that RBC-B12 represents tissue B12 status. Very little is known about what RBC-B12 concentrations really mean. The measurement of RBC-B12 has been deemed insufficiently informative …

A mathematical model for laser in situ keratomileusis and photorefractive keratectomy.

Abstract: PURPOSE The purpose of ablation refractive surgery is to remove the refractive error from the inherently asymmetric aspheric cornea. Although the technique is gaining wide acceptance and popularity, some patients are left with irregular corneas. Our objective was to develop a methodology to analyze corneal shape, reduce the shape to arcs, modify the local arc value to the desired new arc value, and render a new continuous Euclidean surface without discontinuity. METHODS The method to reconstruct the corneal surface consists of importing scanner output elevation data points into a computer-aided design (CAD) application to form the surface model. The corneal arc measurements are derived at 5 degrees increments and centered about the Gauss point of symmetry. Each arc is manipulated to adjust the corresponding arc on the proposed corneal surface to reflect the new arc value, correcting for the refractive error. The method determines the amount of corneal tilt and ablation depth at a given diameter required for the refractive error with a smooth transition zone to the base cornea. RESULTS The case example is a patient who began with a spherical refraction of -8.75 D and after LASIK was emmetropic, but had irregular astigmatism and 20/30 best spectacle-corrected Snellen visual acuity. The proposed mathematical model compares the achieved surface shape to the mathematically planned surface contour. An enhancement procedure to remove the LASIK-induced corneal irregularity was designed. CONCLUSION A mathematical technique to plan myopic ablative surgery to make the corneal surface regular and symmetric is proposed.

Relationship of estrogen and progesterone receptor protein levels in carcinomatous and adjacent non-neoplastic epithelium of the breast : A histopathologic and image cytometric study

Abstract: Background. Results of a previous study demonstrating a correlation between steroid hormone receptor concentrations in benign and tumor tissue in patients with breast carcinoma suggest that receptor levels in breast epithelium undergoing malignant transformation may play a role in determining the receptor levels in the resulting carcinoma. Data used in that study were derived from ligand binding assays and may reflect shortcomings inherent in this methodology, particularly the dilution of receptor proteins from benign and malignant epithelial cells by stromal components.